Prone Position Ventilation In Pediatric Acute Respiratory Distress Syndrome:A Meta Analysis

Objective: This meta-analysis is intended to explore whether there is more improvements in oxygenation and lower mortality in the treatment of certain patient populations when comparing with the supine position ventilation model.Methods and Databases: Two researchers independently retrieved databases in both English and Chinese at the same time,including: EMBASE,the Cochrane Library,Pubmed,Medine,Ovid,the Chinese biomedical literature database,VIP,and science and technology in Chinese journal fulltext database(CNKI),setting time limit from beginning to October 2017.All published researches which type in randomized controlled clinical trials and in accordance with the whole the standard retrieval type was selected.Reading the literature,screening studies according to the included inclusion and exclusion criteria,and then extracting data of included studies.We used Revman 5.3 to carry out quality assessment of the included studies,and graded those randomized controlled trials with the recommending measurement indicators,finally,meta analysised the results of the outcomes of the studies.Results: This meta-analysis retrieved 852 researches and included six randomized controlled trials involving 371 children with acute respiratory distress syndrome.All the enrolled researches reported the oxygen partial pressure and oxygenation index comparing prone position ventilation with supine position ventilation,and part of the researches reported oxygen index and mechanical ventilation time and the mortality.According to meta analysis,we found that the oxygen partial pressure(MD=4.35,95%CI: 2.74~5.96,P<0.001)in the prone position group comparing to supine position group increased significantly;oxygenation index(MD=23.97,95%CI: 16.08~31.86,P<0.001)and oxygen index(MD=-3.52,95%CI:-5.41~-1.64,P=0.002)improved significantly too;while the prone position failed to decrease the mechanical ventilation time(MD=4.41,95%CI:-9.966~ 18.78,P=0.55)and reduce the mortality(RR=0.46,95% CI: 0.19 ~ 1.12,P= 0.09).Conclusion: It is obvious that prone position ventilation can improve the oxygenation in the treatment of pediatric acute respiratory distress syndrome,but there is no significant improvement in mechanical ventilation time and mortality.