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Meta-Analysis
. 2012 Jul 11;2012(7):CD003645.
doi: 10.1002/14651858.CD003645.pub3.

Positioning for acute respiratory distress in hospitalised infants and children

Donna Gillies  1 , Deborah Wells, Abhishta P Bhandari
Affiliations
Meta-Analysis

Positioning for acute respiratory distress in hospitalised infants and children

Donna Gillies et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Because of the association of prone positioning with sudden infant death syndrome (SIDS) it is recommended that young infants be placed on their backs (supine). However, the prone position may be a non-invasive way of increasing oxygenation in participants with acute respiratory distress. Because of substantial differences in respiratory mechanics between adults and children and the risk of SIDS in young infants, a specific review of positioning for infants and young children with acute respiratory distress is warranted.

Objectives: To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress.

Search methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to April week 1, 2012), EMBASE (2004 to April 2012) and CINAHL (2004 to April 2012).

Selection criteria: Randomised controlled trials (RCTs) or pseudo-RCTs comparing two or more positions in the management of infants and children hospitalised with acute respiratory distress.

Data collection and analysis: Two review authors independently extracted data from each study. We resolved differences by consensus or referral to a third review author. We analysed bivariate outcomes using an odds ratio and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference and 95% CI. We used a fixed-effect model unless heterogeneity was significant, in which case we used a random-effects model.

Main results: We extracted data from 53 studies. We included 24 studies with a total of 581 participants. Three studies used a parallel-group, randomised design which compared prone and supine positions only. The remaining 21 studies used a randomised cross-over design. These studies compared prone, supine, lateral, elevated and flat positions.Prone positioning was significantly more beneficial than supine positioning in terms of oxygen saturation (mean difference (MD) 1.97%, 95% CI 1.18 to 2.77), arterial oxygen (MD 6.24 mm Hg, 95% confidence interval (CI) 2.20 to 10.28), episodes of hypoxaemia (MD -3.46, 95% CI -4.60 to -2.33) and thoracoabdominal synchrony (MD -30.76, 95% CI -41.39 to -20.14). No adverse effects were identified. There were no statistically significant differences between any other positions.As the majority of studies did not describe how possible biases were addressed, the potential for bias in these findings is unclear.

Authors' conclusions: The prone position was significantly superior to the supine position in terms of oxygenation. However, as most participants were ventilated preterm infants, the benefits of prone positioning may be most relevant to these infants. In addition, although placing infants and children in the prone position may improve respiratory function, the association of SIDS with prone positioning means that infants should only be placed in this position while under continuous cardiorespiratory monitoring.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 1 Patients with SaO2 < 90%.
1.2
1.2. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 2 PaO2.
1.3
1.3. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 3 PaCO2.
1.4
1.4. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 4 PaO2/FiO2.
1.5
1.5. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 5 Oxygenation Index.
1.6
1.6. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 6 Tidal volume.
1.7
1.7. Analysis
Comparison 1 Prone versus supine: parallel trials, Outcome 7 Adverse events.
2.1
2.1. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 1 SaO2.
2.2
2.2. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 2 PaO2.
2.3
2.3. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 3 tcPCO2.
2.4
2.4. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 4 Oxygenation Index.
2.5
2.5. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 5 Number of episodes SaO2 < 80%.
2.6
2.6. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 6 Respiratory rate.
2.7
2.7. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 7 Tidal volume.
2.8
2.8. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 8 Minute volume.
2.9
2.9. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 9 Work of breathing.
2.10
2.10. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 10 Dynamic lung compliance.
2.11
2.11. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 11 Total pulmonary resistance.
2.12
2.12. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 12 Inspiratory resistance.
2.13
2.13. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 13 Expiratory resistance.
2.14
2.14. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 14 Thoracoabdominal synchrony.
2.15
2.15. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 15 Laboured Breathing Index.
2.16
2.16. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 16 Heart rate.
2.17
2.17. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 17 Number of episodes of heart rate < 90 bpm.
2.18
2.18. Analysis
Comparison 2 Prone versus supine: cross‐over trials, Outcome 18 Oesophageal pressure.
3.1
3.1. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 1 SaO2.
3.2
3.2. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 2 PaO2.
3.3
3.3. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 3 PaCO2.
3.4
3.4. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 4 tcPO2.
3.5
3.5. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 5 tcPCO2.
3.6
3.6. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 6 Tidal volume.
3.7
3.7. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 7 Dynamic lung compliance.
3.8
3.8. Analysis
Comparison 3 Lateral versus supine: cross‐over trials, Outcome 8 Total pulmonary resistance.
4.1
4.1. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 1 PaO2.
4.2
4.2. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 2 PaCO2.
4.3
4.3. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 3 tcPO2.
4.4
4.4. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 4 tcPCO2.
4.5
4.5. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 5 Tidal volume.
4.6
4.6. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 6 Dynamic lung compliance.
4.7
4.7. Analysis
Comparison 4 Right lateral versus left lateral: cross‐over trials, Outcome 7 Total pulmonary resistance.
5.1
5.1. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 1 SaO2.
5.2
5.2. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 2 PaO2.
5.3
5.3. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 3 Number of episodes of SaO2 < 80%.
5.4
5.4. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 4 Respiratory rate.
5.5
5.5. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 5 Heart rate.
5.6
5.6. Analysis
Comparison 5 Elevated versus flat: cross‐over trials, Outcome 6 Number of episodes heart rate < 90 bpm.
6.1
6.1. Analysis
Comparison 6 Supine versus good‐lung dependent: cross‐over trials, Outcome 1 PaO2.
6.2
6.2. Analysis
Comparison 6 Supine versus good‐lung dependent: cross‐over trials, Outcome 2 TcPO2.
6.3
6.3. Analysis
Comparison 6 Supine versus good‐lung dependent: cross‐over trials, Outcome 3 TcPCO2.
6.4
6.4. Analysis
Comparison 6 Supine versus good‐lung dependent: cross‐over trials, Outcome 4 Tidal volume.
6.5
6.5. Analysis
Comparison 6 Supine versus good‐lung dependent: cross‐over trials, Outcome 5 Dynamic lung compliance.
7.1
7.1. Analysis
Comparison 7 Supine versus good‐lung independent: cross‐over trials, Outcome 1 PaO2.
7.2
7.2. Analysis
Comparison 7 Supine versus good‐lung independent: cross‐over trials, Outcome 2 tcPO2.
7.3
7.3. Analysis
Comparison 7 Supine versus good‐lung independent: cross‐over trials, Outcome 3 tcPCO2.
7.4
7.4. Analysis
Comparison 7 Supine versus good‐lung independent: cross‐over trials, Outcome 4 Tidal volume.
7.5
7.5. Analysis
Comparison 7 Supine versus good‐lung independent: cross‐over trials, Outcome 5 Dynamic lung compliance.
8.1
8.1. Analysis
Comparison 8 Good‐lung dependent versus good lung‐independent: cross‐over trials, Outcome 1 PaO2.
8.2
8.2. Analysis
Comparison 8 Good‐lung dependent versus good lung‐independent: cross‐over trials, Outcome 2 tcPO2.
8.3
8.3. Analysis
Comparison 8 Good‐lung dependent versus good lung‐independent: cross‐over trials, Outcome 3 tcPCO2.
8.4
8.4. Analysis
Comparison 8 Good‐lung dependent versus good lung‐independent: cross‐over trials, Outcome 4 Tidal volume.
8.5
8.5. Analysis
Comparison 8 Good‐lung dependent versus good lung‐independent: cross‐over trials, Outcome 5 Dynamic lung compliance.
9.1
9.1. Analysis
Comparison 9 Subgroup analysis by ventilation status: cross‐over trials, Outcome 1 SaO2.
9.2
9.2. Analysis
Comparison 9 Subgroup analysis by ventilation status: cross‐over trials, Outcome 2 Respiratory rate.
9.3
9.3. Analysis
Comparison 9 Subgroup analysis by ventilation status: cross‐over trials, Outcome 3 Tidal volume.
9.4
9.4. Analysis
Comparison 9 Subgroup analysis by ventilation status: cross‐over trials, Outcome 4 Minute volume.
10.1
10.1. Analysis
Comparison 10 Subgroup analysis by age: cross‐over trials, Outcome 1 SaO2.
See this image and copyright information in PMC

Update of

References

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