Is the supine position associated with loss of airway patency in unconscious trauma patients? A systematic review and meta-analysis

Table 6 Summary of Findings (GRADE): Lateral position compared to supine position for patients with reduced consciousness

Outcomes	Illustrative comparative risks (95% CI)		№ of participants	Quality of the evidence
	Assumed risk	Corresponding risk	(Studies)	(GRADE)
	Supine position	Lateral position	(Studies)	(GRADE)
AHI - Adults with sleep apnea	The median AHI (episodes/h) in the control group was 52.4	The mean AHI (episodes/h) in the intervention group was 22.8 fewer (29.1 fewer to16.6 fewer)	2780 (20 observational comparisons) ¹
AHI - Adults before and after surgery	The median AHI (episodes/h) in the control group was 26.0	The mean AHI (episodes/h) in the intervention group was 10.4 fewer (15.2 fewer to 5.6 fewer)	1448 (3 observational comparisons)
AHI - Patients with stroke/TIA	The median AHI (episodes/h) in the control group was 23	The mean AHI (episodes/h) in the intervention group was 13.9 fewer (20.9 fewer to 6.8 fewer)	196 (2 observational studies)
AHI - Infants and small children	The median AHI (episodes/h) in the control group was 2.5	The mean AHI (episodes/h) in the intervention group was 0.74 more (0.6 fewer to 2.08 more)	190 (9 observational comparisons)

1. Three more studies were not included: Not sufficient data for analysis given.
2. Studies in which patients were their own controls.
3. In a number of the studies there was unclear bias regarding representativity, but internal validity was intact so we did not downgrade for this.
4. Unexplained heterogeneity regarding the size of effect, but a clear effect estimate in favor of the intervention. We upgraded for large effect.
5. Indirectness in population.
6. Small cumulative sample size, but clear benefit.
7. Unexplained heterogeneity regarding direction of effect, I²=90%, we downgraded for this uncertainty.
8. CI 95% includes both benefit and harm, but clinically insignificant difference.

ISSN: 1757-7241