Tommaso Pettenuzzo, Eleonora Balzani, Nicolò Sella, Marco Giani, Mara Bassi, Valentina Fincati, Rossella Cescon, Giorgia Pacchiarini, Giovanna Pandolfo, Roberta Ceccato, Lars Grønlykke, Dawid L. Staudacher, Nicolas Nesseler, Senta Jorinde Raasveld, Michele Carron, Elisa Pistollato, Giulia Mormando, Francesco Zarantonello, Alessandro De Cassai, Annalisa Boscolo, Emanuele Rezoagli, Giuseppe Foti, Paolo Navalesi
{"title":"静脉-静脉体外膜氧合时俯卧位：系统回顾和荟萃分析","authors":"Tommaso Pettenuzzo, Eleonora Balzani, Nicolò Sella, Marco Giani, Mara Bassi, Valentina Fincati, Rossella Cescon, Giorgia Pacchiarini, Giovanna Pandolfo, Roberta Ceccato, Lars Grønlykke, Dawid L. Staudacher, Nicolas Nesseler, Senta Jorinde Raasveld, Michele Carron, Elisa Pistollato, Giulia Mormando, Francesco Zarantonello, Alessandro De Cassai, Annalisa Boscolo, Emanuele Rezoagli, Giuseppe Foti, Paolo Navalesi","doi":"10.1007/s00134-025-07877-2","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42–0.98, p = 0.040, I<sup>2</sup> = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54–0.83, p < 0.001, I<sup>2</sup> = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"7 1","pages":""},"PeriodicalIF":27.1000,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis\",\"authors\":\"Tommaso Pettenuzzo, Eleonora Balzani, Nicolò Sella, Marco Giani, Mara Bassi, Valentina Fincati, Rossella Cescon, Giorgia Pacchiarini, Giovanna Pandolfo, Roberta Ceccato, Lars Grønlykke, Dawid L. Staudacher, Nicolas Nesseler, Senta Jorinde Raasveld, Michele Carron, Elisa Pistollato, Giulia Mormando, Francesco Zarantonello, Alessandro De Cassai, Annalisa Boscolo, Emanuele Rezoagli, Giuseppe Foti, Paolo Navalesi\",\"doi\":\"10.1007/s00134-025-07877-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Purpose</h3><p>The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42–0.98, p = 0.040, I<sup>2</sup> = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54–0.83, p < 0.001, I<sup>2</sup> = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.</p>\",\"PeriodicalId\":13665,\"journal\":{\"name\":\"Intensive Care Medicine\",\"volume\":\"7 1\",\"pages\":\"\"},\"PeriodicalIF\":27.1000,\"publicationDate\":\"2025-04-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Intensive Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00134-025-07877-2\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00134-025-07877-2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis
Purpose
The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.
Methods
A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments.
Results
We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42–0.98, p = 0.040, I2 = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54–0.83, p < 0.001, I2 = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning.
Conclusion
In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.
期刊介绍：
Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
