Efficacy of prone positioning in awake ventilation for COVID-19: Umbrella review

Awake-prone positioning was widely used in COVID-19, combined with high-flow nasal oxygen therapy or noninvasive ventilation, effectively reducing intubation, and the effect on mortality is controversial. We aim to reevaluate the efficacy of awake-prone positioning in COVID-19 and summarize the protocol for awake-prone positioning.

We gathered data on the treatment of COVID-19 using awake-prone positioning from Web of Science, Cochrane Library, Embase, PubMed, and CNKI. All the included studies were published between 2019 and 2023. Two researchers used the Assessment of Multiple Systematic Reviews tool to assess the methodological quality of the literature. The evidence was assessed using the Grading of Recommendations Assessment and Evaluation system.

Thirteen articles were included. The quality assessment using AMSTAR2 revealed that 3 articles were high quality, and 4 were moderate quality. The evidence quality assessment of 41 primary outcomes by the Grading of Recommendations Assessment, Development and Evaluation indicates that 9 indicators were of moderate quality, 21 were of low quality, and 6 were of very low quality.

The review demonstrates high methodological quality, but the evidence quality of its outcome indicators is low. Awake-prone position has been shown to decrease intubation and improve oxygenation in COVID-19 patients. It is recommended to consult the latest quality assessment standards to develop more rigorous experimental protocols, improve research quality, and facilitate the translation of research findings.