Clinical benefits of prone positioning in the treatment of non-intubated patients with acute hypoxic respiratory failure: a rapid systematic review.

BACKGROUND: The COVID-19 pandemic has led to a surge in critically unwell patients with type 1 respiratory failure. In an attempt to reduce the number of patients requiring mechanical ventilation, prone positioning (PP) of non-intubated patients has been added to many hospital guidelines around the world. We set out to conduct a systematic review of the evidence relating to PP in the non-intubated patient with type 1 respiratory failure secondary to COVID-19 and other causes. METHODS: The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search of major databases and grey sources was conducted. Studies were assessed for inclusion by two authors according to prespecified criteria. Data collection processes, analysis and risk of bias assessment were planned. RESULTS: 31 studies were included for analysis. These consisted of prospective and retrospective case series, cohort studies and case reports. None of the studies included a comparison group. No statistical analysis was performed. Descriptive data of included studies and narrative synthesis are presented. CONCLUSIONS: No high-quality randomised controlled trials were found and thus evidence in relation to PP as a treatment for non-intubated patients with type 1 respiratory failure is lacking.

The Cochrane Library as a resource for evidence on out-of-hospital health care interventions.

STUDY OBJECTIVE: Although the Cochrane Library is promoted as a rigorous source of evidence, the relevance of this evidence to the out-of-hospital setting has not been assessed. The objective of this study is to identify existing controlled trials and systematic reviews in the Cochrane Library that have been conducted in or are relevant to out-of-hospital health care. The scope of out-of-hospital care, the years and trends of out-of-hospital research publication, and the journals of publication are also examined. METHODS: Using a search strategy developed by the Cochrane Prehospital and Emergency Health Field, 2 reviewers searched issue 4, 2005 of the Cochrane Library to identify reports of controlled trials and systematic reviews on out-of-hospital interventions. Three independent reviewers screened the titles identified by the search strategy and applied predetermined criteria to classify the reported study as out-of-hospital based or not out-of-hospital based. The out-of-hospital-based studies were then categorized as randomized or nonrandomized trials. RESULTS: Screening of the 19,759 titles retrieved by the search strategy identified 4,016 studies that were potentially out-of-hospital based. Abstract and full-text analysis of the 4,016 studies identified 400 reports of trials and 13 reviews or protocols that were out-of-hospital based. Of the 400 reports of trials identified, 299 (75%) were randomized trials. The number of out-of-hospital trials published increased steadily from the 1970s to the late 1990s, with the majority of trials (63%) covering interventions related to resuscitation and cardiac care. Annals of Emergency Medicine published more out-of-hospital trials than any other journal, followed by Resuscitation and Journal of the American Medical Association. CONCLUSION: The Cochrane Library provides a useful resource of health care evidence; however, the relatively small number of out-of-hospital-based systematic reviews and trials does not comprehensively cover the broad scope of out-of-hospital health care.