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Updated: Sep 5, 2025

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Prone ventilation in intubated COVID-19 patients: a systematic review and meta-analysis

Ee Xin Chua1, Zhen Zhe Wong2, Mohd Shahnaz Hasan1

  • 1Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia.

Brazilian Journal of Anesthesiology (Elsevier)
|July 9, 2022
PubMed

Insights

Prone ventilation improved oxygenation in intubated COVID-19 patients, enhancing the arterial/alveolar oxygen ratio and peripheral saturation. However, evidence quality is low, necessitating further research on mortality and adverse events.

Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Infectious Diseases

Background:

  • The effectiveness and safety of prone ventilation for intubated COVID-19 patients require further clarification.
  • This study aimed to assess the impact of prone positioning on oxygenation in mechanically ventilated COVID-19 patients.

Approach:

  • A systematic review and meta-analysis of studies published up to March 2021 was conducted.
  • Eleven studies involving 606 intubated COVID-19 patients were included, excluding case reports and series.

Key Points:

  • Prone ventilation significantly improved the PaO2/FiO2 ratio (mean difference 46.75) and SpO2 (mean difference 1.67).
  • No significant improvements were observed in PaCO2, mortality rates, or the number of patients discharged alive.
  • The evidence supporting these findings was rated as very low to low.

Conclusions:

  • Prone ventilation enhances oxygenation (PaO2/FiO2 ratio and SpO2) in intubated COVID-19 patients.
  • Substantial heterogeneity and low evidence quality necessitate more randomized controlled trials.
  • Further research should focus on confirming these benefits and evaluating potential adverse events.
Abstract

Keywords:
Acute respiratory distress syndromeCOVID-19IntubationProne positionSupine positionVentilation

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