title: Using the prone position for ventilated patients with respiratory failure: a review.
abstract: OBJECTIVE
  this review explored the evidence relating to prone positioning in ventilated patients diagnosed with respiratory failure, including acute lung injury (ALI) or adult respiratory distress syndrome (ARDS).
  
  
  BACKGROUND
  mortality rates for ventilated patients with ALI or ARDS are high, and there is a growing body of evidence suggesting that the position these patients are nursed in may influence clinical outcomes. However, there are no guidelines to inform nursing practice in positioning these patients.
  
  
  METHODS
  Medline, Scopus, Cinahl and the Cochrane Library databases were searched for original research reports or systematic reviews of evidence between 2000 and 2009. Reference lists of retrieved papers were hand searched and included studies were analysed using the Critical Appraisal and Skills Programme framework. A narrative data synthesis considered the strengths and limitations of studies, and findings were collated and interpreted.
  
  
  RESULTS
  Application of the search strategy identified a systematic review, currently underway, which has not yet reported and 14 relevant studies eligible for inclusion in this review. Analysis showed considerable variation in study design, but suggests that PaO(2) /FiO(2) ratio, incidence of VAP and mortality may be positively affected by prone positioning.
  
  
  CONCLUSIONS
  evidence of the clinical benefits associated with prone positioning is inconclusive and provides little guidance for nursing practice. There is a need for further research into the clinical outcomes of prone positioning, and greater understanding of the practicalities of prone positioning critically ill patients is required.
  
  
  CONCLUSIONS
  nurses have a central role to play in the continual assessment and management of this patient group, including the position they are nursed in, not only to ensure the best clinical outcomes but also to provide care and comfort to the patient and their family. It is therefore important that their nursing practice and interventions are informed by the best available evidence.
authors.affiliation: School of Health Sciences, University of Liverpool, Liverpool, UK. adwright@liverpool.ac.uk
authors.forename: Angie D
authors.initials: AD
authors.lastname: Wright
authors.forename: Maria
authors.initials: M
authors.lastname: Flynn
mesh_terms: D055371:Acute Lung Injury / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D055317:Evidence-Based Practice; D006801:Humans; D024802:Nurse's Role; D009730:Nursing Assessment; D017410:Practice Guidelines as Topic; D016684:Prone Position; D012107:Research Design; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality / Q000451:nursing*; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012131:Respiratory Insufficiency / Q000378:metabolism / Q000401:mortality / Q000628:therapy*