TY - JOUR
T1 - An appraisal of the methodology and quality of evidence of systematic reviews on the efficacy of prone positional ventilation in adult patients with acute respiratory distress syndrome
T2 - an umbrella review
AU - Noeding Fischer, Carlo Heinz Richard Matthias
AU - Bocanegra Román, Nicole Fabiola Alexandra
AU - Nieto-Gutierrez, Wendy
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
PY - 2023/4
Y1 - 2023/4
N2 - The objective of the study was to evaluate all available systematic reviews on the use of prone positional ventilation in adult patients with acute respiratory distress syndrome (ARDS). An umbrella review on the efficacy of prone positional ventilation in adult patients ventilation in adult patients with acute respiratory distress syndrome was conducted. We performed a systematic search in the database of Medline (Pubmed), Scopus, Cochrane Library, Web of Science, and Epistemonikos. The ROBIS tools and GRADE methodology were used to assess the risk of bias and certainty of evidence. We estimated the necessary number of patients to be treated to have benefit. For the synthesis of the result, we selected the review with the lowest risk of bias. Sixteen systematic reviews including 64 randomized clinical trials and evaluating the effect of prone positional ventilation, with or without other ventilation strategies were included. Aoyama 2019 observed prone positioning, without complementary ventilation strategies, leading to a reduction in the 28-day mortality only when compared to high-frequency oscillatory ventilation (RR 0.61; 95% CI 0.39–0.95) and lung-protective ventilation in the supine position (RR 0.69; 95% CI 0.48–0.98), with an ARR of 9.32% and 14.94%, an NNTB of 5.89 and 8.04, and a low and moderate certainty of evidence, respectively. Most reviews had severe methodological flaws that led to results with very low certainty of evidence. The review with the lowest risk of bias presented results in favor of prone positional ventilation compared with high-frequency oscillatory ventilation and lung-protective ventilation. There is a need to update the available reviews to obtain more accurate results.
AB - The objective of the study was to evaluate all available systematic reviews on the use of prone positional ventilation in adult patients with acute respiratory distress syndrome (ARDS). An umbrella review on the efficacy of prone positional ventilation in adult patients ventilation in adult patients with acute respiratory distress syndrome was conducted. We performed a systematic search in the database of Medline (Pubmed), Scopus, Cochrane Library, Web of Science, and Epistemonikos. The ROBIS tools and GRADE methodology were used to assess the risk of bias and certainty of evidence. We estimated the necessary number of patients to be treated to have benefit. For the synthesis of the result, we selected the review with the lowest risk of bias. Sixteen systematic reviews including 64 randomized clinical trials and evaluating the effect of prone positional ventilation, with or without other ventilation strategies were included. Aoyama 2019 observed prone positioning, without complementary ventilation strategies, leading to a reduction in the 28-day mortality only when compared to high-frequency oscillatory ventilation (RR 0.61; 95% CI 0.39–0.95) and lung-protective ventilation in the supine position (RR 0.69; 95% CI 0.48–0.98), with an ARR of 9.32% and 14.94%, an NNTB of 5.89 and 8.04, and a low and moderate certainty of evidence, respectively. Most reviews had severe methodological flaws that led to results with very low certainty of evidence. The review with the lowest risk of bias presented results in favor of prone positional ventilation compared with high-frequency oscillatory ventilation and lung-protective ventilation. There is a need to update the available reviews to obtain more accurate results.
KW - Evidence-based medicine (source MeSH)
KW - Prone position
KW - Respiration, Artificial
KW - Respiratory distress syndrome
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85145311714&partnerID=8YFLogxK
U2 - 10.1007/s11739-022-03174-8
DO - 10.1007/s11739-022-03174-8
M3 - Artículo de revisión
AN - SCOPUS:85145311714
SN - 1828-0447
VL - 18
SP - 691
EP - 709
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 3
ER -