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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: an umbrella review

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Abstract

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.

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  1. Universidad Científica del Sur, Lima, Perú

    Carlo Heinz-Richard Matthias Noeding Fischer, Nicole Fabiola Alexandra Bocanegra Román & Wendy Nieto-Gutierrez

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  1. Carlo Heinz-Richard Matthias Noeding Fischer
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Carlo Heinz-Richard Matthias Noeding Fischer—financial interests: the author had no relevant financial interests to disclose; non-financial interests: the author have no relevant non-financial interests to disclose. Nicole Fabiola Alexandra Bocanegra Román—financial interests: the author had no relevant financial interests to disclose; non-financial interests: the author had no relevant non-financial interests to disclose. Wendy Nieto-Gutierrez—financial interests: the author had no relevant financial interests to disclose; non-financial interests: the author have no relevant non-financial interests to disclose.

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Noeding Fischer, C.HR.M., Bocanegra Román, N.F.A. & Nieto-Gutierrez, W. 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: an umbrella review. Intern Emerg Med 18, 691–709 (2023). https://doi.org/10.1007/s11739-022-03174-8

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