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The efficacy and tolerance of prone positioning in non-intubation patients with acute hypoxemic respiratory failure and ARDS: a meta-analysis.
Tan, Wei; Xu, Dong-Yang; Xu, Meng-Jiao; Wang, Zan-Feng; Dai, Bing; Li, Li-Li; Zhao, Hong-Wen; Wang, Wei; Kang, Jian.
  • Tan W; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Xu DY; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Xu MJ; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Wang ZF; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Dai B; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning 110001, China.
  • Li LL; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning 110001, China.
  • Zhao HW; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Wang W; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Kang J; Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
Ther Adv Respir Dis ; 15: 17534666211009407, 2021.
Article in English | MEDLINE | ID: covidwho-1199884
ABSTRACT
BACKGROUND AND

AIMS:

The application of prone positioning with acute hypoxemic respiratory failure (AHRF) or acute respiratory distress syndrome (ARDS) in non-intubation patients is increasing gradually, applying prone positioning for more high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) patients. This meta-analysis evaluates the efficacy and tolerance of prone positioning combined with non-invasive respiratory support in patients with AHRF or ARDS.

METHODS:

We searched randomized controlled trials (RCTs) (prospective or retrospective cohort studies, RCTs and case series) published in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 1 July 2020. We included studies that compared prone and supine positioning with non-invasive respiratory support in awake patients with AHRF or ARDS. The meta-analyses used random effects models. The methodological quality of the RCTs was evaluated using the Newcastle-Ottawa quality assessment scale.

RESULTS:

A total of 16 studies fulfilled selection criteria and included 243 patients. The aggregated intubation rate and mortality rate were 33% [95% confidence interval (CI) 0.26-0.42, I2 = 25%], 4% (95% CI 0.01-0.07, I2 = 0%), respectively, and the intolerance rate was 7% (95% CI 0.01-0.12, I2 = 5%). Prone positioning increased PaO2/FiO2 [mean difference (MD) = 47.89, 95% CI 28.12-67.66; p < 0.00001, I2 = 67%] and SpO2 (MD = 4.58, 95% CI 1.35-7.80, p = 0.005, I2 = 97%), whereas it reduced respiratory rate (MD = -5.01, 95% CI -8.49 to -1.52, p = 0.005, I2 = 85%). Subgroup analyses demonstrated that the intubation rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 34% and 21%, respectively; and the mortality rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 6% and 0%, respectively. PaO2/FiO2 and SpO2 were significantly improved in COVID-19 patients and non-COVID-19 patients.

CONCLUSION:

Prone positioning could improve the oxygenation and reduce respiratory rate in both COVID-19 patients and non-COVID-19 patients with non-intubated AHRF or ARDS.The reviews of this paper are available via the supplemental material section.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Patient Positioning / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Ther Adv Respir Dis Journal subject: Pulmonary Disease (Specialty) / Therapeutics Year: 2021 Document Type: Article Affiliation country: 17534666211009407

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Patient Positioning / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Ther Adv Respir Dis Journal subject: Pulmonary Disease (Specialty) / Therapeutics Year: 2021 Document Type: Article Affiliation country: 17534666211009407