Prone positioning responsiveness in critically ill adults with ARDS: a scoping review of definitions and physiological constructs.
Le résumé fourni par la source
Prone position ventilation has been demonstrated to reduce mortality among patients with moderate/severe ARDS receiving lung-protective ventilation. However, 'prone position responsiveness' is widely used in the literature without formalised definition and with little standardisation. This scoping review aims to systematically map how prone position responsiveness has been defined in adults with ARDS, and to characterise the physiological constructs used across the literature in order to better characterize the state of the evidence on this problem. By mapping the existing definitions and physiological constructs used to define prone positioning response is an important step toward standardising research approaches. It is hoped that we will be well placed to follow this scoping review with a robust Delphi study to generate consensus. Variability in the definitions of 'responsiveness' to prone positioning in ARDS complicates the interpretation and comparison of studies, limits the ability to synthesise evidence, and may hinder identification of physiologically meaningful responder phenotypes. We will examine the range of domains used to define prone position responsiveness, examine the thresholds of change used to define responsiveness, assess the timing of responsiveness, and consider how responsiveness is associated with outcome data. We will assess what domains are used to indicate that a patient may no longer be prone-position responsive, and whether this associates with escalation decisions such as initiation of ECLS. Our primary outcome questions is: What definitions and physiological constructs have been used to define ‘response to prone positioning’ in adults with ARDS? Our secondary outcome questions are: -Which physiological domains define ‘response’? -What thresholds are used? -What timing defines ‘response’? -Are responses associated with/translate into clinical outcomes?
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