Awake Proning Reduces the Likelihood of Intubation and Mortality in Adult COVID-19 Patients With Acute Hypoxemic...

Purpose: To estimate the extent to which awake prone positioning (APP), in comparison to usual care, reduces the incidence of intubation and mortality in non-intubated patients with acute hypoxemic respiratory failure (AHRF) secondary to COVID-19. Method: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Physiotherapy Evidence Database, and Scopus were searched from January 1, 2020, to August 2, 2023, for randomized controlled trials (RCTs) of adult COVID-19 patients with AHRF who have received APP intervention. Data on the incidence of intubation and mortality were extracted. The odds ratio for intubation and mortality were pooled together using the fixed-effects model. Results: The search identified 1,082 studies from which 17 RCTs involving 3,873 participants were included. Pooled data showed that APP was associated with a 29% decreased likelihood of intubation (OR 0.71 [95% CI: 0.61, 0.84]). The pooled OR for mortality provided some evidence that APP is associated with an 18% decreased likelihood of mortality (OR 82 [95% CI: 0.69, 0.98]). Conclusion: Evidence from this review shows that APP is associated with reduced odds of intubation and mortality in non-intubated patients with COVID-19. We conclude that APP has some benefits in improving morbidity and reducing mortality among patients with COVID-19-related cardiopulmonary compromise.