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Положение лежа на животе при острой дыхательной недостаточности у взрослых

Información

DOI:
https://doi.org/10.1002/14651858.CD008095.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 13 noviembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Atención crítica y de emergencia

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Roxanna Bloomfield

    Intensive Care Unit and Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK

  • David W Noble

    Correspondencia a: Intensive Care Unit and Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK

    [email protected]

    [email protected]

  • Alexis Sudlow

    Luton and Dunstable Hospital, Luton, UK

Contributions of authors

Conceiving of the review: Roxanna Bloomfield (RB), David W. Noble (DWN).
Co‐ordinating the review: RB, DWN.
Undertaking manual searches: RB, DWN.
Screening search results: RB, DWN.
Organizing retrieval of papers: RB, DWN.
Screening retrieved papers against inclusion criteria: RB, DWN.
Appraising quality of papers: RB, DWN, Alexis Sudlow (AS).
Abstracting data from papers: RB, DWN, AS.
Writing to authors of papers for additional information: DWN.
Providing additional data about papers:
Obtaining and screening data on unpublished studies: RB, DWN.
Managing data for the review: RB, DWN.
Entering data into Review Manager (RevMan 5.40): RB, DWN, AS.
Analysing RevMan statistical data: DWN.
Performing other statistical analyses not using RevMan: DWN
Performing double entry of data: (data entered by person one: RB; data entered by person two: DWN).
Interpreting data: RB, DWN, AS.
Making statistical inferences: RB, DWN.
Writing the review: RB, DWN, AS.
Securing funding for the review:
Performing previous work that served as the foundation of the present study:
Serving as guarantor for the review (one review author): DWN.
Taking responsibility for reading and checking the review before submission: AS.

Sources of support

Internal sources

  • NHS Grampian, UK

External sources

  • No sources of support supplied

Declarations of interest

Roxanna Bloomfield: none known.

David W Noble: none known.

Alexis Sudlow: none known.

Acknowledgements

We would like to thank Dr Harald Herkner (Content Editor) and Dr Claude Guerin and Dr Spyros D. Mentzelopoulos (Peer Reviewers) for help and editorial advice provided during preparation of the protocol (Bloomfield 2009).

In addition, we would like to thank Dr Harald Herkner (Content Editor); Nathan Pace (Statistical Editor); Jean‐Louis Vincent, Spyros D Mentzelopoulos and Thordis Thomsen (Peer Reviewers); and Anne Lyddiatt (Consumer) for help and editorial advice provided during preparation of the original version of this systematic review (Bloomfield 2015).

We would like to thank Xuan Yu, Qiangqiang Guo for their assistance with study translation. We also thank Dr Zhou Quanhong MSc MD PhD for assessment and translation of some studies published in Chinese.

Finally we wish to acknowledge the invaluable assistance of Teo Aminah Wasteneys Quay and Janne Vendt for this update as well as the enormous amount encouragement and help of Jane Cracknell in preparation of the original version of this Cochrane Review. Insert full acknowledgements for this update. 

Version history

Published

Title

Stage

Authors

Version

2015 Nov 13

Prone position for acute respiratory failure in adults

Review

Roxanna Bloomfield, David W Noble, Alexis Sudlow

https://doi.org/10.1002/14651858.CD008095.pub2

2009 Oct 07

Prone position for acute respiratory failure in adults

Protocol

Roxanna Bloomfield, David W Noble, Nigel R Webster

https://doi.org/10.1002/14651858.CD008095

Differences between protocol and review

We made the following changes to the protocol (Bloomfield 2009).

  • We replaced Nigel Webster, who had insufficient time to assist with the review process, with Alexis Sudlow.

  • We added references and Background text.

  • We made the definition of tidal volume more specific for the purpose of identifying studies that employed "lung‐protective ventilation" (i.e. tidal volume should be expressed in mL per kg of ideal body weight.

  • Risk of bias methods for a Cochrane review have changed since protocol publication, and we reanalysed data for the new format.

  • The GRADE‐based summary of findings table has been introduced since protocol publication, and we have therefore retrospectively chosen the analyses displayed.

  • We did not employ the Q‐partitioning method (Deeks 2011) in exploring heterogeneity and used the I2 approach recommended instead.

  • We made minor modifications to search strategies for Ovid MEDLINE, EMBASE, CENTRAL, CINAHL and LILACS to better suit their updated search engines.

  • We changed the cutoff for prolonged duration of prone positioning from 18 or more hours per day to 16 or more hours per day. This placed the last published study (Guerin 2013) in the more biologically appropriate category for analysis. (The mean duration of proning in the short‐duration proning group was 8.3 hours per day, and for the long‐duration proning group 18.1 hours per day, and one study aiming for 20 hours per day actually achieved 17 hours per day (Mancebo 2006). The study of Guerin et al (Guerin 2013) also achieved proning for a mean of 17 hours per day.)

Notes

The present interim amendment includes an updated search (May 2020, no new trials identified), and search of trial registries (November 2020, 3 ongoing studies identified). Review text was updated to reflect advances in knowledge since the original review and the availability of new data from secondary analyses; however, a complete update of this review is pending. 

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Flow diagram of results from updated search (January 2014 to 1st May 2020)

Figuras y tablas -
Figure 1

Flow diagram of results from updated search (January 2014 to 1st May 2020)

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Funnel plot of comparison: 1 Mortality, outcome: 1.1 Mortality.

Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Mortality, outcome: 1.1 Mortality.

Primary RCTs incorporated in various published Systematic Reviews.Green denotes primary study was incorporated; Pink denotes primary study was not utilised; Yellow denotes primary study was not available to reviewers. *Yue_17 also included non‐RCT.

Figuras y tablas -
Figure 5

Primary RCTs incorporated in various published Systematic Reviews.

Green denotes primary study was incorporated; Pink denotes primary study was not utilised; Yellow denotes primary study was not available to reviewers. *Yue_17 also included non‐RCT.

Comparison 1: Mortality, Outcome 1: Mortality

Figuras y tablas -
Analysis 1.1

Comparison 1: Mortality, Outcome 1: Mortality

Comparison 1: Mortality, Outcome 2: Sub‐group analysis (SGA) of mortality < 16 hours/d prone

Figuras y tablas -
Analysis 1.2

Comparison 1: Mortality, Outcome 2: Sub‐group analysis (SGA) of mortality < 16 hours/d prone

Comparison 1: Mortality, Outcome 3: SGA of mortality prone ≥ 16 hours/d

Figuras y tablas -
Analysis 1.3

Comparison 1: Mortality, Outcome 3: SGA of mortality prone ≥ 16 hours/d

Comparison 1: Mortality, Outcome 4: SGA of mortality: enrolled ≤ 48 hours after entry criteria met/ventilation

Figuras y tablas -
Analysis 1.4

Comparison 1: Mortality, Outcome 4: SGA of mortality: enrolled ≤ 48 hours after entry criteria met/ventilation

Comparison 1: Mortality, Outcome 5: SGA of mortality: enrolled > 48 hours after entry criteria met/ventilation

Figuras y tablas -
Analysis 1.5

Comparison 1: Mortality, Outcome 5: SGA of mortality: enrolled > 48 hours after entry criteria met/ventilation

Comparison 1: Mortality, Outcome 6: SGA of severe hypoxaemia at entry

Figuras y tablas -
Analysis 1.6

Comparison 1: Mortality, Outcome 6: SGA of severe hypoxaemia at entry

Comparison 1: Mortality, Outcome 7: SGA of less severe hypoxaemia at entry

Figuras y tablas -
Analysis 1.7

Comparison 1: Mortality, Outcome 7: SGA of less severe hypoxaemia at entry

Comparison 1: Mortality, Outcome 8: SGA of SAPS II ≤ 49/≥ 50: short‐term mortality

Figuras y tablas -
Analysis 1.8

Comparison 1: Mortality, Outcome 8: SGA of SAPS II ≤ 49/≥ 50: short‐term mortality

Comparison 1: Mortality, Outcome 9: SGA of low tidal volume (mean 6 to 8 mL/kg IBW)

Figuras y tablas -
Analysis 1.9

Comparison 1: Mortality, Outcome 9: SGA of low tidal volume (mean 6 to 8 mL/kg IBW)

Comparison 1: Mortality, Outcome 10: SGA of high tidal volume (> 8 mL/kg IBW)

Figuras y tablas -
Analysis 1.10

Comparison 1: Mortality, Outcome 10: SGA of high tidal volume (> 8 mL/kg IBW)

Comparison 1: Mortality, Outcome 11: SGA of ARDS only

Figuras y tablas -
Analysis 1.11

Comparison 1: Mortality, Outcome 11: SGA of ARDS only

Comparison 2: Intervention comparisons and interactions, Outcome 1: Longer duration vs shorter duration of proning: longer‐term mortality

Figuras y tablas -
Analysis 2.1

Comparison 2: Intervention comparisons and interactions, Outcome 1: Longer duration vs shorter duration of proning: longer‐term mortality

Comparison 2: Intervention comparisons and interactions, Outcome 2: Early enrolment vs later enrolment to intervention: longer‐term mortality

Figuras y tablas -
Analysis 2.2

Comparison 2: Intervention comparisons and interactions, Outcome 2: Early enrolment vs later enrolment to intervention: longer‐term mortality

Comparison 2: Intervention comparisons and interactions, Outcome 3: Severe vs less‐severe hypoxaemia: longer‐term mortality

Figuras y tablas -
Analysis 2.3

Comparison 2: Intervention comparisons and interactions, Outcome 3: Severe vs less‐severe hypoxaemia: longer‐term mortality

Comparison 2: Intervention comparisons and interactions, Outcome 4: Lower tidal volume (TV) ventilation vs higher TV ventilation: longer‐term mortality

Figuras y tablas -
Analysis 2.4

Comparison 2: Intervention comparisons and interactions, Outcome 4: Lower tidal volume (TV) ventilation vs higher TV ventilation: longer‐term mortality

Comparison 3: Pneumonia, Outcome 1: Pneumonia

Figuras y tablas -
Analysis 3.1

Comparison 3: Pneumonia, Outcome 1: Pneumonia

Comparison 4: Duration of mechanical ventilation, Outcome 1: Duration of mechanical ventilation

Figuras y tablas -
Analysis 4.1

Comparison 4: Duration of mechanical ventilation, Outcome 1: Duration of mechanical ventilation

Comparison 5: Length of stay (LOS), Outcome 1: ICU LOS

Figuras y tablas -
Analysis 5.1

Comparison 5: Length of stay (LOS), Outcome 1: ICU LOS

Comparison 6: Mean change in PaO2/FIO2 quotient (mmHg), Outcome 1: Mean increase in PaO2/FIO2 quotient (mmHg) at 7 or 10 days

Figuras y tablas -
Analysis 6.1

Comparison 6: Mean change in PaO2/FIO2 quotient (mmHg), Outcome 1: Mean increase in PaO2/FIO2 quotient (mmHg) at 7 or 10 days

Comparison 7: Adverse events, Outcome 1: Adverse events

Figuras y tablas -
Analysis 7.1

Comparison 7: Adverse events, Outcome 1: Adverse events

Summary of findings 1. Mortality: prone position compared with supine for acute respiratory failure in adults requiring mechanical ventilation in intensive care

Mortality: prone position compared with supine for acute respiratory failure in adults requiring mechanical ventilation in intensive care

Patient or population: adults with acute respiratory failure
Settings:
Intervention: mortality: prone position compared with supine

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Mortality: prone position compared with supine

Short‐term mortality (STM)
Alive or dead
Follow‐up: 10 to 30 days

Study population

RR 0.84
(0.69 to 1.02)

2117
(8 studies)

⊕⊕⊝⊝
Lowa,b

383 per 1000

322 per 1000
(264 to 391)

Moderate

450 per 1000

378 per 1000
(310 to 459)

Longer‐term mortality (LTM)
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.86
(0.72 to 1.03)

2141
(8 studies)

⊕⊕⊝⊝
Lowa,b

470 per 1000

404 per 1000
(339 to 484)

Moderate

525 per 1000

452 per 1000
(378 to 541)

Subgroup analysis of longer‐term mortality: severe hypoxaemia
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.77
(0.65 to 0.92)

977
(7 studies)

⊕⊕⊕⊝
Moderatea

547 per 1000

421 per 1000
(356 to 503)

Moderate

653 per 1000

503 per 1000
(424 to 601)

Subgroup analysis of longer‐term mortality: lower tidal volume ventilation
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.73
(0.55 to 0.96)

911
(5 studies)

⊕⊕⊕⊝
Moderatea

451 per 1000

329 per 1000
(248 to 433)

Moderate

523 per 1000

382 per 1000
(288 to 502)

Subgroup analysis of longer‐term mortality: ARDS only
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.85
(0.71 to 1.01)

1758
(8 studies)

⊕⊕⊕⊝
Moderatea

483 per 1000

411 per 1000
(343 to 488)

Moderate

522 per 1000

444 per 1000
(371 to 527)

Subgroup analysis of longer‐term mortality:16 hours/d prone
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.77
(0.61 to 0.99)

1005
(5 studies)

⊕⊕⊕⊝
Moderatea

470 per 1000

362 per 1000
(286 to 465)

Moderate

526 per 1000

405 per 1000
(321 to 521)

Subgroup analysis of longer‐term mortality: enrolment48 hours after entry criteria/ventilation
Alive or dead
Follow‐up: 31 to 180 daysc

Study population

RR 0.75
(0.59 to 0.94)

1024
(5 studies)

⊕⊕⊕⊝
Moderatea

469 per 1000

352 per 1000
(277 to 441)

Moderate

523 per 1000

392 per 1000
(309 to 492)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aBlinding of participants and carers was not possible. Researchers also may not have been adequately blinded. All analyses were downgraded because of this important potential bias, leading the quality of all subgroup analyses to be rated as moderate
bFor the primary outcomes, inconsistency across studies reflected different patient populations, different management strategies generally and differences in adaptations to resulting effects of the intervention. This led to further downgrading of the quality of evidence for the primary outcomes to low
cLonger‐term mortality = 31 to 180 days OR hospital mortality

Figuras y tablas -
Summary of findings 1. Mortality: prone position compared with supine for acute respiratory failure in adults requiring mechanical ventilation in intensive care
Comparison 1. Mortality

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Mortality Show forest plot

9

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1.1 Short‐term mortality

8

2117

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.69, 1.02]

1.1.2 Longer‐term mortality

8

2140

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.72, 1.03]

1.2 Sub‐group analysis (SGA) of mortality < 16 hours/d prone Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.2.1 Short‐term mortality

2

1095

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.89, 1.21]

1.2.2 Longer‐term mortality

3

1135

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.92, 1.17]

1.3 SGA of mortality prone ≥ 16 hours/d Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.3.1 Short‐term mortality

6

1022

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.58, 0.93]

1.3.2 Longer‐term mortality prone

5

1005

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.61, 0.99]

1.4 SGA of mortality: enrolled ≤ 48 hours after entry criteria met/ventilation Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.4.1 Short‐term mortality

5

1000

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.56, 0.93]

1.4.2 Longer‐term mortality

5

1024

Risk Ratio (M‐H, Random, 95% CI)

0.75 [0.59, 0.94]

1.5 SGA of mortality: enrolled > 48 hours after entry criteria met/ventilation Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.5.1 Short‐term mortality

3

1117

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.89, 1.21]

1.5.2 Longer‐term mortality

3

1116

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.92, 1.17]

1.6 SGA of severe hypoxaemia at entry Show forest plot

8

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.6.1 Short‐term mortality

6

744

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.70, 0.95]

1.6.2 Longer‐term mortality

7

977

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.65, 0.92]

1.7 SGA of less severe hypoxaemia at entry Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.7.1 Short‐term mortality

4

1095

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.87, 1.21]

1.7.2 Longer‐term mortality

6

1108

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.93, 1.21]

1.8 SGA of SAPS II ≤ 49/≥ 50: short‐term mortality Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.8.1 SAPS II ≤ 49

2

327

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.45, 1.60]

1.8.2 SAPS II ≥ 50

2

113

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.25, 1.40]

1.9 SGA of low tidal volume (mean 6 to 8 mL/kg IBW) Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.9.1 Short‐term mortality

3

830

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.43, 1.20]

1.9.2 Longer‐term mortality

5

911

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.55, 0.96]

1.10 SGA of high tidal volume (> 8 mL/kg IBW) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.10.1 Short‐term mortality

3

1231

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.86, 1.14]

1.10.2 Longer‐term mortality

3

1231

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.90, 1.13]

1.11 SGA of ARDS only Show forest plot

9

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.11.1 Short‐term mortality

7

1326

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.63, 1.00]

1.11.2 Longer‐term mortality

8

1758

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.71, 1.01]

Figuras y tablas -
Comparison 1. Mortality
Comparison 2. Intervention comparisons and interactions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Longer duration vs shorter duration of proning: longer‐term mortality Show forest plot

8

2140

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.73, 1.04]

2.1.1 > 16 hours

5

1005

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.61, 0.99]

2.1.2 ≤ 16 hours prone

3

1135

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.92, 1.18]

2.2 Early enrolment vs later enrolment to intervention: longer‐term mortality Show forest plot

8

2140

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.72, 1.03]

2.2.2 Late enrolment > 48 hours

3

1116

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.92, 1.17]

2.2.3 Early enrolment ≤ 48 hours

5

1024

Risk Ratio (M‐H, Random, 95% CI)

0.75 [0.59, 0.94]

2.3 Severe vs less‐severe hypoxaemia: longer‐term mortality Show forest plot

7

2085

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.76, 1.03]

2.3.1 Severe hypoxaemia

7

977

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.65, 0.92]

2.3.2 Less severe hypoxaemia

6

1108

Risk Ratio (M‐H, Random, 95% CI)

1.07 [0.92, 1.26]

2.4 Lower tidal volume (TV) ventilation vs higher TV ventilation: longer‐term mortality Show forest plot

8

2183

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.72, 1.01]

2.4.1 Lower TV ‐ mean 6 to 8 mL/kg IBW

5

911

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.55, 0.96]

2.4.2 High TV ‐ mean > 8 mL/kg IBW

4

1272

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.88, 1.12]

Figuras y tablas -
Comparison 2. Intervention comparisons and interactions
Comparison 3. Pneumonia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Pneumonia Show forest plot

5

1473

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.80, 1.18]

Figuras y tablas -
Comparison 3. Pneumonia
Comparison 4. Duration of mechanical ventilation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Duration of mechanical ventilation Show forest plot

3

871

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐1.53, 0.59]

Figuras y tablas -
Comparison 4. Duration of mechanical ventilation
Comparison 5. Length of stay (LOS)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 ICU LOS Show forest plot

5

1775

Mean Difference (IV, Fixed, 95% CI)

1.06 [‐1.13, 3.26]

Figuras y tablas -
Comparison 5. Length of stay (LOS)
Comparison 6. Mean change in PaO2/FIO2 quotient (mmHg)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Mean increase in PaO2/FIO2 quotient (mmHg) at 7 or 10 days Show forest plot

4

827

Mean Difference (IV, Fixed, 95% CI)

24.03 [13.35, 34.71]

6.1.1 Change data provided

2

268

Mean Difference (IV, Fixed, 95% CI)

16.71 [0.11, 33.32]

6.1.2 Calculated change data

2

559

Mean Difference (IV, Fixed, 95% CI)

29.19 [15.24, 43.14]

Figuras y tablas -
Comparison 6. Mean change in PaO2/FIO2 quotient (mmHg)
Comparison 7. Adverse events

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Adverse events Show forest plot

10

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1.1 Pressure ulcers

4

823

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [1.06, 1.48]

7.1.2 Tracheal tube displacement

8

2021

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.85, 1.39]

7.1.3 Tracheal tube obstruction

3

1597

Risk Ratio (M‐H, Fixed, 95% CI)

1.72 [1.35, 2.18]

7.1.4 Pneumothorax

4

664

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.65, 2.08]

7.1.5 Arrhythmias

3

642

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.47, 0.87]

Figuras y tablas -
Comparison 7. Adverse events