Characterization of Global Research Trends and Prospects on Prone Positioning in Respiratory Failure: Bibliometric Analysis

Abstract

Background: Prone positioning has emerged as a crucial intervention in managing acute respiratory failure, especially in acute respiratory distress syndrome and patients with COVID-19. Given the increasing interest in this field, it is important to characterize global research trends and key contributors to identify future research directions.

Objective: This study aimed to analyze global research trends, collaboration networks, and research hotspots related to prone positioning in respiratory failure through a comprehensive bibliometric analysis.

Methods: Bibliometric analyses were conducted using CiteSpace and Biblioshiny software on publications up to December 31, 2023, from the Web of Science Core Collection, focusing on prone positioning in respiratory failure.

Results: A total of 1263 research articles were identified, published in 50 countries by numerous institutions. The United States, France, and Germany contributed the most publications, with the United States producing 21.9% (275/1263) of the total. Key authors such as Claude Guerin and Luciano Gattinoni were identified as major contributors to the field. Keyword co-occurrence analysis revealed the dynamic nature of prone positioning research in respiratory failure. It highlighted protective ventilation and COVID-19-related acute respiratory distress syndrome as emerging hotspots, indicating a shift in focus during the pandemic.

Conclusions: This study revealed a rapidly growing body of literature on prone positioning in respiratory failure, especially in the context of COVID-19. The findings underscore the importance of further multicenter clinical trials to validate current practices and refine treatment protocols. In addition, the application of prone positioning in non-intubated patients represents a potential future research direction.

Keywords: ARF; COVID-19; SARS-CoV-2; acute respiratory distress syndrome; acute respiratory failure; bibliometric analysis; bibliometrics; coronavirus; critical care; infectious; lungs; pandemic; prone positioning; pulmonary; respiratory failure.

Figure 1.. Record identification and selection.

Figure 2.. Annual scientific production. This figure shows the annual number of publications on prone positioning in respiratory failure from 1977 to 2023. The first publication appeared in 1977, with only 1 to 5 articles per year before 1995. From 1995 to 2018, there was a gradual increase in publications. A significant rise in the number of publications occurred from 2019 to 2023, with 199 publications in 2021.

Figure 3.. Corresponding author’s country distribution. This figure presents the distribution of single-country publications and multiple-country publications by country.

Figure 4.. Authors and institutions. (A) Top 10 Authors with the Strongest Citation Bursts. This panel displays the top 10 authors with the strongest citation bursts in the field of prone positioning and respiratory failure. The red line segments represent the time periods of citation bursts, while the burst strength indicates the intensity of citation activity, with higher values reflecting stronger bursts. (B) Co-authorship network Visualization. This panel visualizes the co-authorship network in prone positioning research. Nodes represent authors, and edges between nodes represent co-authorship relationships. The network highlights key authors and their collaboration patterns over time.(C) Network of Co-authors’ Institution Visualization. This panel illustrates the co-authorship network at the institutional level. Nodes represent institutions, and edges between them reflect collaborative publishing efforts. The network highlights prominent institutions and their involvement in global research initiatives on prone positioning and respiratory failure.

Figure 5.. Authors and institutions. (A) Bradford Law bibliometrix. (B) Most relevant journals. (C) Impact index of journals.

Figure 6.. Co-occurring author keywords analysis. (A) Co-occurring author keywords network Visualization. This panel visualizes the network of co-occurring author keywords related to prone positioning and respiratory failure. Nodes represent individual keywords, and edges between nodes indicate the co-occurrence relationships. The network highlights the most frequently mentioned and connected terms in the research field.(B) Top 25 Keywords with the Strongest Citation Bursts. This panel presents the top 25 keywords with the strongest citation bursts, reflecting trends in the research over time. The red line segments represent the time periods of citation bursts, while the burst strength indicates the intensity of citation activity, with higher values reflecting stronger bursts.