tetano
Editor, Senior Moderator
Intern Emerg Med
. 2023 Oct 5.
doi: 10.1007/s11739-023-03434-1. Online ahead of print. Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis
Mara Graziani[SUP] 1 [/SUP], Andrea Galeazzo Rigutini[SUP] 2 [/SUP], Diletta Bartolini[SUP] 2 [/SUP], Laura Traballi[SUP] 2 [/SUP], Lorenzo Luzi[SUP] 2 [/SUP], Rossana Regina[SUP] 2 [/SUP], Francesco Bossi[SUP] 2 [/SUP], Carla Caponi[SUP] 2 [/SUP], Cecilia Becattini[SUP] 2 [/SUP]
Affiliations
The role of awake prone positioning (aPP) in patients with acute hypoxemic respiratory failure is debated. We performed a systematic review and meta-analysis to evaluate the role of aPP in acute respiratory failure related to COronaVIrus Disease-19 (COVID-19). Studies reporting on the clinical course of patients with acute respiratory failure related to COVID-19 treated or not treated by aPP were included in the systematic review and meta-analysis (ProsperoID: CRD42022333211). The primary study outcome was the composite of in-hospital death or orotracheal intubation; the individual components of the primary outcome were secondary study outcomes. The composite of in-hospital death or orotracheal intubation was available for 6 studies (1884 patients), five randomized and one prospective; a significant reduction in the risk of this outcome was observed in patients treated vs. not treated by aPP (33.5% vs. 39.8%; OR 0.73, 95% CI 0.60-0.89; I[SUP]2[/SUP] 0%). In-hospital death was reported in 34 studies (6808 patients) and occurred in 17.4% vs. 23.5% of patients treated or not treated with aPP (random effect OR 0.60, 95% CI 0.46-0.79; I[SUP]2[/SUP] 59%); orotracheal intubation was observed in 25.8% vs. 32.7% of patients treated or not treated with aPP (27 studies, 5369 patients; random effect OR 0.85, 95% CI 0.56-1.27; I[SUP]2[/SUP] 84%). aPP reduces the risk for death or orotracheal intubation in patients with acute respiratory failure related to COVID-19. Further studies should be conducted to confirm the clinical benefit of aPP outside the ICU.Registration Prospero ID: CRD42022333211.
Keywords: Acute respiratory distress syndrome; Awake prone positioning; COVID-19; Hypoxemic respiratory failure; Respiratory failure; SARS-CoV-2.
. 2023 Oct 5.
doi: 10.1007/s11739-023-03434-1. Online ahead of print. Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis
Mara Graziani[SUP] 1 [/SUP], Andrea Galeazzo Rigutini[SUP] 2 [/SUP], Diletta Bartolini[SUP] 2 [/SUP], Laura Traballi[SUP] 2 [/SUP], Lorenzo Luzi[SUP] 2 [/SUP], Rossana Regina[SUP] 2 [/SUP], Francesco Bossi[SUP] 2 [/SUP], Carla Caponi[SUP] 2 [/SUP], Cecilia Becattini[SUP] 2 [/SUP]
Affiliations
- PMID: 37796372
- DOI: 10.1007/s11739-023-03434-1
The role of awake prone positioning (aPP) in patients with acute hypoxemic respiratory failure is debated. We performed a systematic review and meta-analysis to evaluate the role of aPP in acute respiratory failure related to COronaVIrus Disease-19 (COVID-19). Studies reporting on the clinical course of patients with acute respiratory failure related to COVID-19 treated or not treated by aPP were included in the systematic review and meta-analysis (ProsperoID: CRD42022333211). The primary study outcome was the composite of in-hospital death or orotracheal intubation; the individual components of the primary outcome were secondary study outcomes. The composite of in-hospital death or orotracheal intubation was available for 6 studies (1884 patients), five randomized and one prospective; a significant reduction in the risk of this outcome was observed in patients treated vs. not treated by aPP (33.5% vs. 39.8%; OR 0.73, 95% CI 0.60-0.89; I[SUP]2[/SUP] 0%). In-hospital death was reported in 34 studies (6808 patients) and occurred in 17.4% vs. 23.5% of patients treated or not treated with aPP (random effect OR 0.60, 95% CI 0.46-0.79; I[SUP]2[/SUP] 59%); orotracheal intubation was observed in 25.8% vs. 32.7% of patients treated or not treated with aPP (27 studies, 5369 patients; random effect OR 0.85, 95% CI 0.56-1.27; I[SUP]2[/SUP] 84%). aPP reduces the risk for death or orotracheal intubation in patients with acute respiratory failure related to COVID-19. Further studies should be conducted to confirm the clinical benefit of aPP outside the ICU.Registration Prospero ID: CRD42022333211.
Keywords: Acute respiratory distress syndrome; Awake prone positioning; COVID-19; Hypoxemic respiratory failure; Respiratory failure; SARS-CoV-2.