RESUMEN
Background: Prone positioning has evolved as a therapeutic intervention for patients with acute respiratory distress syndrome (ARDS). ARDS remains a critical condition, with a mortality rate of approximately 40%. Prone positioning, which involves placing patients in a face-down position, has the potential to enhance gas exchange and improve lung mechanics, possibly leading to better patient outcomes. Objectives: This comprehensive review aims to evaluate the impact of prone positioning on mortality (primary outcome) and the occurrence of adverse events (secondary outcome) in patients with ARDS compared to conventional supine positioning. Methods: We conducted an extensive systematic review, including studies published from 2000 to 2022. We searched databases including PUBMED, MEDLINE, EMBASE, CENTRAL, and WEB OF SCIENCE. Only randomized controlled trials (RCTs) that compared the outcomes of patients with ARDS in prone and supine positions were included. We employed the Cochrane risk of bias instrument to assess the methodological quality of the included RCTs. Results: Our review included a total of twelve RCTs involving 2736 patients, with 1401 patients in the prone position. The meta-analysis demonstrated a lower mortality rate among patients in the prone position compared to those in the supine position (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.52-0.98; P = .04). Notably, there was a higher incidence of pressure sores in patients placed in the prone position (OR, 0.15; 95% CI, 0.09-0.20) compared to those in the supine position. However, there were no statistically significant differences in the occurrence of arrhythmias, unplanned extubation, or pneumothorax between the two positioning strategies. Conclusions: Prone positioning offers potential benefits for patients with ARDS by reducing mortality rates. However, it is important to note that there is an associated risk of pressure sores. Further research and clinical consideration are needed to optimize the use of prone positioning in ARDS management.