Ocular injury associated with prone positioning in adult critical care: A systematic review and meta-analysis protocol.

Timothy Patterson*, Peter Currie, Jonathan Beck, Michael Williams, Claire Shevlin

*Corresponding author for this work

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Prone positioning in critical care has been shown to improve oxygenation in patients with acute respiratory distress syndrome. During the COVID19 pandemic it has become increasing popular as a management therapy, but is associated with a significant adverse event profile.

This study was the first systematic review and meta-analysis of ocular injuries reported in randomised controlled trials (RCTs) comparing supine versus prone positioning in adult critical care patients.

A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. PubMed, SCOPUS and the Cochrane Library were searched. The search period was 1st January 1990 toill 1st July 2020. This review was registered with PROSPERO: CRD42020196917. Eleven RCTs were included, with 2,247 patients.

The incidence of eye injury was 1.12% and 1.19% in the prone and supine groups, reducing to 0.17% and 0.18% respectively when reports of eye or eyelid oedema were removed. Meta-analysis demonstrated no significant difference between the supine and prone groups: the risk ratio (RR) was 1.02 [95% confidence interval (CI) 0.82, 1.26], and without patients with reported oedema was 0.79 [CI 0.11, 5.44].

This meta-analysis showed that there was no significant difference in the rate of ocular injury between prone and supine patient groups in adult critical care. It is notable that this is higher than the incidence reported during general anaesthesia. There is a need for studies in critical care settings in which ocular injury is a prespecified end-point, and the duration of follow-up is longer than discharge from critical care. Intensivists should be aware that ocular injuries do occur in critical care, and this should influence post admission guidance.
Original languageEnglish
Publication statusAccepted - 26 Feb 2021


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