{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T11:25:02Z","timestamp":1787138702777,"version":"build-2736575974"},"reference-count":33,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Prone positioning is a recommended therapy for patients with moderate-to-severe ARDS; however, the optimal duration of this maneuver is still unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis comparing clinical outcomes of extended (\u226524 h) versus traditional prone positioning (16\u201324 h) of adults with moderate-to-severe ARDS receiving\u00a0invasive mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Ten studies involving 2,412 subjects\u00a0met the inclusion criteria, including one randomized controlled trial and 9 observational studies, all with COVID-19-related ARDS. Extended prone positioning was associated with reduced mortality compared with the traditional approach (risk ratio [RR]: 0.76, 95% CI 0.66\u20130.86,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 12.8%). Sensitivity and subgroup analyses confirmed consistency across risk of bias, baseline P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        iO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      , and PEEP levels. No differences were found in duration of mechanical ventilation (mean difference [MD]: 2.43 days, 95% CI \u22121.06 to 5.92,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 70%) or ICU stay (MD: 1.31 days, 95% CI \u22121.07 to 3.68,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 55%). The extended strategy was associated with a higher incidence of pressure injuries (RR: 1.30, 95% CI 1.02\u20131.65,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 56%) but no differences in device displacement or hemodynamic instability. Certainty of evidence was rated as low to very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Extended prone positioning was associated with reduced mortality in ARDS but increased risk of pressure injuries, without impact on ventilator duration or ICU stay. While this strategy appears feasible and potentially beneficial, further randomized trials are warranted to confirm its role in routine practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>PROSPERO no. CRD42024529311.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654251405270","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T09:48:06Z","timestamp":1770112086000},"page":"417-425","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extended Prone Positioning in ARDS: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"71","author":[{"given":"Mariana","family":"Berger do Ros\u00e1rio","sequence":"first","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, Rios Vieira, Boniatti and Prof. Ziegelmann are affiliated with Cardiology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."},{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo Warpechowski","family":"da Silva","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuri Christmann","family":"Wawrzeniak","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia Klarmann","family":"Ziegelmann","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, Rios Vieira, Boniatti and Prof. Ziegelmann are affiliated with Cardiology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."},{"name":"Prof. Ziegelmann is affiliated with Statistics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia Regina","family":"Rios Vieira","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, Rios Vieira, Boniatti and Prof. Ziegelmann are affiliated with Cardiology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rcio Manozzo","family":"Boniatti","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, Rios Vieira, Boniatti and Prof. Ziegelmann are affiliated with Cardiology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."},{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil."},{"name":"Dr. Boniatti is affiliated with School of Medicine, Universidade La Salle, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassiano","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil."},{"name":"Prof. Teixeira and Dr. Oliveira are affiliated with Pneumology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Martins de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Dr. Berger do Ros\u00e1rio, da Silva, Wawrzeniak, Boniatti, Oliveira and Prof. Teixeira are affiliated with Intensive Care Department, Hospital de Cl\u00ednicas de Porto Alegre, 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