Prone positioning compared with standard care for ARDS
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Standard Care | Prone Positioning | |||||
| Mortality (pooled) | 467 per 1000 | 421 per 1000 (383 to 458) | RR 0.90 (0.82 to 0.98) | 2141 (eight studies) | +--- VERY LOW Due to serious risk of bias, very serious inconsistency and serious indirectness | Failure to blind outcome, failure of allocation concealment, and incomplete outcome data Includes sub-groups receiving additional interventions known to demonstrate a potential mortality benefit |
| Subgroup analysis Prone positioning with lung protective ventilation Mortality | 447 per 1000 | 326 per 1000 (277 to 384) | RR 0.73 (0.62 to 0.86) | 910 (five studies) | +++- MODERATE Due to serious risk of bias | Failure to blind outcome, failure of allocation concealment, and incomplete outcome data |
| Subgroup analysis Prone positioning without lung protective ventilation Mortality | 483 per 1000 | 488 per 1000 (435 to 546) | RR 1.01 (0.9 to 1.13) | 1231 (three studies) | +++- MODERATE Due to serious risk of bias | See above |
| Subgroup analysis Prone positioning for more than 12 hours Mortality | 479 per 1000 | 359 per 1000 (311 to 416) | RR 0.75 (0.65 to 0.87) | 1006 (five studies) | +++- MODERATE Due to serious risk of bias | See above |
| Subgroup analysis Prone positioning for less than 12 hours Mortality | 457 per 1000 | 471 per 1000 (416 to 535) | RR 1.03 (0.91 to 1.17) | 1135 (three studies) | +++- MODERATE Due to serious risk of bias | See above |
| Adverse events (pooled) | 188 per 1000 | 207 per 1000 (190 to 226) | RR 1.10 (1.01 to 1.2) | 7377 (seven studies) | +--- VERY LOW Due to serious risk of bias and very serious inconsistency | Failure to blind outcome, failure of allocation concealment, and incomplete outcome data |
| Adverse events: cardiac events | 278 per 1000 | 281 per 1000 (242 to 325) | RR 1.01 (0.87 to 1.17) | 1599 (three studies) | +--- VERY LOW Due to serious risk of bias and very serious inconsistency | Failure to blind outcome, failure of allocation concealment, and incomplete outcome data Cohort includes subgroups receiving additional interventions known to demonstrate a potential mortality benefit for example, lung- protective ventilation |
| Adverse events: endotracheal tube displacement | 101 per 1000 | 134 per 1000 (103 to 176) | RR 1.33 (1.02 to 1.74) | 1597 (five studies) | ++-- LOW Due to serious risk of bias and serious imprecision | See above |
| Adverse events: ventilator-associated pneumonia | 248 per 1000 | 218 per 1000 (176 to 270) | RR 0.88 (0.71 to 1.09) | 1007 (four studies) | ++-- LOW Due to serious risk of bias and serious imprecision | See above |
| Adverse events: pressure sores | 375 per 1000 | 462 per 1000 (402 to 529) | RR 1.23 (1.07 to 1.41) | 1095 (two studies) | ++-- LOW Due to serious risk of bias and serious imprecision | See above |
| Adverse events: pneumothorax | 67 per 1000 | 58 per 1000 (40 to 87) | RR 0.87 (0.59 to 1.30) | 1160 (four studies) | ++-- LOW Due to serious risk of bias and serious imprecision | See above |
| Adverse events: loss of venous access | 49 per 1000 | 97 per 1000 (54 to 174) | RR 1.98 (1.11 to 3.55) | 646 (two studies) | +--- VERY LOW Due to serious risk of bias, very serious inconsistency and serious imprecision | See above |