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

Patterson, Timothy J; Currie, Peter; Williams, Michael; Shevlin, Claire

PURPOSE Prone positioning, during the COVID-19 pandemic, has become increasingly utilised as an adjunct to increase oxygenation in critical care patients. It is associated with an adverse event profile. We sought to study the occurrence of ocular injuries reported in prone versus supine groups in adult critical care. DESIGN Systematic review and meta-analysis. METHODS 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 - 1st July 2020. This review was registered with PROSPERO: CRD42020196917. RESULTS Eleven RCTs were included, with 2,247 patients. Twenty-eight events were recorded in 3 trials (174 patients) and no events in the other 8 trials (2,073 patients). The incidence of eye injury was 1.30% (15 events / 1158 patients) and 1.19% (13 / 1089) in the prone and supine groups, reducing to 0.17% (2 / 1158) and 0.18% (2 / 1089) respectively when reports of eye or eyelid oedema were removed. Meta-analysis demonstrated no significant difference between groups: with, odds ratio (OR) 1.40 [95% confidence interval (CI) 0.37, 5.27], and without, OR 0.78 [CI 0.11, 5.73], patients with reported oedema. CONCLUSIONS This meta-analysis showed no significant difference in the rate of reported ocular injury between prone and supine critical care groups. These rates remain higher than the incidence reported during general anaesthesia. There is a need for studies in critical care settings in which ocular injury is an end-point and which include extended patient follow-up.