title: Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation.
  
  
  METHODS
  We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013. We included RCTs that compared prone and supine positioning during mechanical ventilation in patients with ARDS. We assessed risk of bias and obtained data on all-cause mortality (determined at hospital discharge or, if unavailable, after longest follow-up period). We used random-effects models for the pooled analyses.
  
  
  RESULTS
  We identified 11 RCTs (n=2341) that met our inclusion criteria. In the 6 trials (n=1016) that used a protective ventilation strategy with reduced tidal volumes, prone positioning significantly reduced mortality (risk ratio 0.74, 95% confidence interval 0.59-0.95; I2=29%) compared with supine positioning. The mortality benefit remained in several sensitivity analyses. The overall quality of evidence was high. The risk of bias was low in all of the trials except one, which was small. Statistical heterogeneity was low (I2<50%) for most of the clinical and physiologic outcomes.
  
  
  CONCLUSIONS
  Our analysis of high-quality evidence showed that use of the prone position during mechanical ventilation improved survival among patients with ARDS who received protective lung ventilation.
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Sachin
authors.initials: S
authors.lastname: Sud
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Jan O
authors.initials: JO
authors.lastname: Friedrich
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Paolo
authors.initials: P
authors.lastname: Taccone
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Federico
authors.initials: F
authors.lastname: Polli
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Martha A Q
authors.initials: MA
authors.lastname: Curley
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernandez
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Ming-Cheng
authors.initials: MC
authors.lastname: Chan
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Pascal
authors.initials: P
authors.lastname: Beuret
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Gregor
authors.initials: G
authors.lastname: Voggenreiter
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Maneesh
authors.initials: M
authors.lastname: Sud
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Institute for Better Health and Division of Critical Care (S. Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Interdepartmental Division of Critical Care (S. Sud, Friedrich, Adhikari), University of Toronto, Toronto, Ont.; Departments of Critical Care and Medicine, and Li Ka Shing Knowledge Institute (Friedrich), St. Michael's Hospital, Toronto, Ont.; Dipartimento di Anestesia e Rianimazione (Taccone, Gattinoni, Polli), Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Istituto di Anestesiologia e Rianimazione (Polli, Gattinoni), Università degli Studi di Milano, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (Gattinoni), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Department of Critical Care Medicine (Adhikari), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Cardiovascular Research (Latini), Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Dipartimento di Medicina Perioperatoria e Terapie Intensive (Pesenti), Azienda Ospedaliera San Gerardo, Monza, Italy; Dipartimento di Medicina Sperimentale (Pesenti), Università degli Studi di Milano-Bicocca, Milan, Italy; Service de Réanimation Médicale et Assistance Respiratoire (Guérin), Hôpital de la Croix-Rousse, Lyon, France; Servei de Medicina Intensiva (Mancebo), Hospital de Sant Pau, Barcelona, Spain; University of Pennsylvania School of Nursing (Curley), Philadelphia, Pa.; Intensive Care Unit (Fernandez), Hospital Sant Joan de Deu - Fundacio Althaia, CIBERES, Manresa, Spain; Universitat Internacional de Catalunya (Fernandez), Barcelona, Spain; Section of Chest Medicine (Chan), Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Physiology (Chan), National Yang-Ming University, Taipei, Taiwan; Service de Réanimation (Be
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
mesh_terms: D014943:Global Health; D006801:Humans; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate / Q000639:trends