ABSTRACT
Background We aimed to investigate the effects of awake prone positioning (APP) in acute hypoxemic, non-intubated patients due to COVID-19 infections.Methods A collection of databases including PubMed, EMBASE, Web of Science and Cochrane Central Register were searched up to June 1, 2022. All randomized trials investigating the effects of the APP were included in the present meta-analysis. The primary outcome was intubation rate, and the secondary outcome included the length of intensive care unit (ICU) and hospital stay, and mortality. Prescribed sub-group analysis was also conducted.Results A total of 10 randomized trials enrolling 2324 patients were finally included in the present study. The results indicated APP was associated with a significant reduction of intubation rate (OR 0.77, 95% CI 0.63 to 0.93, P = 0.007). However, no differences could be observed in length of ICU stay or hospitalization, or mortality. Sub-group analysis suggested that patients in the ICU settings (OR 0.74, 95% CI 0.60 to 0.91, P = 0.004), patients whose median APP time was more than 4 hours (OR 0.77, 95% CI 0.63 to 0.93, P = 0.008), and patients with an average baseline SpO2 to FiO2 ratio less than 200 mmHg (OR 0.75, 95% CI 0.61 to 0.92) were more likely to benefit from APP with significant reduced intubation rate.Conclusion Based on the current evidence, non-intubated patients with hypoxemic respiratory failure due to COVID-19 infection conducted with APP was associated with significantly induced intubation rate. However, no differences in ICU or hospital length of stay, or mortality could be observed between APP and usual care.
Subject(s)
COVID-19 , Respiratory InsufficiencyABSTRACT
Background: Ventilatory ratio is a simple bedside index of impaired efficiency of ventilation and correlates well with physiological dead space fraction in patients with ARDS. So it was regarded as a dead-space marker associated with mortality in mechanically ventilated adults with ARDS. However, the association between VR and outcome of patients with ARDS remains largely unknown. Methods: : We searched articles in three electronic databases including PubMed, EMBASE and Web of Science. All the English publications up to 1 st Oct. 2021 will be searched without any restriction of countries. All the observational study that investigated the association between ventilatory ratio and the mortality of ARDS patients were identified in this meta-analysis. The main outcome was mortality. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes with accompanying 95% confidence interval (CI) were expressed. Results: : A total of 9 trials enrolling 5638 patients were finally included in this meta-analysis. The results revealed that the use of ventilatory ratio could be significantly related to the mortality in adult ARDS (OR=1.27; 95% CI 1.10 to 1.47; P=0.001). Ventilatory ratio may have the capability of predicting the mortality of NON- COVID-related patients (OR 1.39, 95% CI 1.12 to 1.73 P = 0.003) while it has no predictable significance in patients with COVID (OR 1.18, 95% CI 0.94 to 1.48 P = 0.16). Importantly, the dynamic changes of VR adds more predictable value (OR 1.21 vs 1.19). Conclusion: Our study suggests that ventilatory ratio can be regarded as a valuable marker to predict the mortality of adult patients with ARDS. Compared to patients with COVID, ventilatory ratio is more predictable in patients with NON-COVID. What’s more, the dynamic changes of VR may have the potential to improve the prognostic value.