Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews.

Jan 22, 2024

Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients.
We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05.
Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[- 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[- 4.441, 7.723]; P-value = 0.597).
Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation.
PROSPERO registration number: CRD42022326951. Registered 25 April 2022.

© 2024. The Author(s).

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ABOUT THE EXPERTS

Sepideh Tahsini Tekantapeh,Nader D Nader,Morteza Ghojazadeh,Fatemeh Fereidouni,Hassan Soleimanpour
Sepideh Tahsini Tekantapeh

Student Research Committee, Department of Rheumatology, Tabriz University of Medical Sciences, Tabriz, Iran.

Nader D Nader

Departments of Anesthesiology and Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.

Morteza Ghojazadeh

Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Fatemeh Fereidouni

Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

Hassan Soleimanpour

Integrated Aging Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. h.soleimanpour@gmail.com.