Awake prone positioning for non-intubated COVID-19 patients with acute respiratory failure: A meta-analysis of randomised controlled trials

Cheema, Huzaifa Ahmad, Siddiqui, Amna, Ochani, Sidhant, Adnan, Alishba, Sukaina, Mahnoor, Haider, Ramsha, Shahid, Abia, Rehman, Mohammad Ebad Ur, Awan, Rehmat Ullah, Singh, Harpreet, Duric, Natalie, Fazzini, Brigitta, Torres, Antoni and Szakmany, Tamas ORCID: https://orcid.org/0000-0003-3632-8844 2023. Awake prone positioning for non-intubated COVID-19 patients with acute respiratory failure: A meta-analysis of randomised controlled trials. Journal of Clinical Medicine 12 (3) , 926. 10.3390/jcm12030926

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Abstract

Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74–0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77–1.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Type: open-access
Publisher:	MDPI
Date of First Compliant Deposit:	6 February 2023
Date of Acceptance:	22 January 2023
Last Modified:	08 May 2023 18:34
URI:	https://orca.cardiff.ac.uk/id/eprint/156529

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