Background: Obesity is a worldwide epidemic that is expected to grow exponentially in the future. Obese patients are at risk of developing serious complications including acute respiratory distress syndrome (ARDS). Prone positioning (PP) has been shown to increase survival rates in patients with ARDS, but few studies have focused on the effect of PP on obese patients. This systematic review seeks to explore the research performed on the question: in obese adults with ARDS, can prone positioning increase the likelihood of morbidity or mortality when compared to supine positioning?
Methods: A comprehensive search of available medical literature was performed using MEDLINE-Ovid, CINAHL, and Web of Science using the following search terms: acute respiratory distress syndrome, prone position, and obesity. Quality of all relevant articles were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation criteria (GRADE).
Results: Two articles met the inclusion criteria and provided original data regarding the clinical question. These articles included two retrospective observational studies. An observational case-control clinical study with 66 patients demonstrated that length of mechanical ventilation, intensive care unit (ICU) stay, and nosocomial infections did not differ significantly between obese and non-obese patients in PP, but mortality was significantly lower in obese patients. A retrospective observational study found that there was no significant difference in overall ICU mortality. However, it was found that obese patients developed renal and hepatic failure more often.
Conclusion: Prone positioning has been shown to reduce the rate of mortality in patients with ARDS. Current studies show that PP can also reduce mortality in obese patients, however studies conflict on their results regarding morbidity. Therefore more quality studies must be performed to determine the safety of PP in obese patients.
Keywords: prone positioning, obesity, ARDS, respiratory distress syndrome, adult
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