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

ABSTRACT

Abstract Background The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. Results Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence very low) and peripheral oxygen saturation (SpO2) (studies 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p= 0.32; evidence very low), mortality rate (studies 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p= 0.24; evidence very low), or number of patients discharged alive (studies 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p= 0.28; evidence very low). Conclusion Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.