Awake Prone Decubitus Positioning in COVID-19 Patients: A Systematic Review and MetaAnalysis

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Current recommendations for awake prone positioning in SARS-CoV-2 patients with hypoxia are based on studies of general respiratory distress.
• The specific benefits of prone positioning for COVID-19 patients require further investigation.

Purpose of the Study:

• To systematically review and meta-analyze the impact of awake prone positioning on oxygenation, endotracheal intubation (ETI), and mortality in SARS-CoV-2 patients.
• To evaluate the efficacy of prone positioning in improving respiratory outcomes for COVID-19 patients.

Main Methods:

• A systematic search of PubMed and Embase databases was conducted from June 2020 to November 2021.
• A random-effects meta-analysis was performed to assess the effects of pronation on ETI and mortality rates.
• Subgroup analysis, including randomized clinical trials (RCTs), was conducted.

Main Results:

• A significant reduction in mortality was observed in patients undergoing prone positioning (RR = 0.69; 95% CI: 0.48–0.99; p = 0.044).
• No significant overall effect on the need for ETI was found (RR = 0.79; 95% CI: 0.63–1.00; p = 0.051).
• Subgroup analysis of RCTs showed a significant decrease in the need for ETI (RR = 0.83; 95% CI: 0.71–0.97).

Conclusions:

• Awake prone positioning significantly reduces mortality in SARS-CoV-2 patients with hypoxia.
• Prone positioning may decrease the need for endotracheal intubation, particularly when implemented early and in conjunction with non-invasive ventilation or high-flow nasal cannula therapy.
• The reduction in ETI was statistically significant in the subgroup analysis of RCTs, highlighting its potential benefit.