PRAGUE MEDICAL REPORT
PRAGUE MEDICAL REPORT
Prague Medical Report je víceoborový biomedicínský časopis publikující původní recenzované vědecké články, přehledové a případové studie a krátké zprávy v angličtině. Časopis založený v roce 1885 jako Sborník lékařský vychází čtyřikrát ročně.

PRAGUE MEDICAL REPORT, Vol 123 No 3 (2022), 140–165

Clinical Outcomes of Routine Awake Prone Positioning in COVID-19 Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Woon Hean Chong, Biplab K. Saha, Chee Keat Tan

DOI: https://doi.org/10.14712/23362936.2022.14
zveřejněno: 15. 09. 2022

Abstract

Before coronavirus disease 2019 (COVID-19) emerged, proning had been demonstrated to improve oxygenation in those with acute hypoxic respiratory failure and be performed in non-intensive care settings. This benefit was further exemplified by the COVID-19 pandemic, leading to awake prone positioning (APP). We assessed the efficacy of routine APP versus standard care in preventing death and invasive mechanical ventilation (IMV) in non-intubated hypoxic COVID-19 patients. PubMed, Cochrane Library, Scopus, and medRxiv databases were used from January 1st, 2020, to January 15th, 2022, to identify randomized controlled trials (RCTs). Routine APP group were encouraged to be self-prone, whereas the standard care group received care according to local clinical practice and allowed APP crossover as rescue therapy. We included eight COVID-19 RCTs assessing 809 APP vs. 822 standard care patients. APP group had less IMV requirement (26.5% vs. 30.9%; OR – odds ratio 0.77; P=0.03) than the standard care group, with subgroup analysis showing greater benefit (32.5% vs. 39.1%; OR 0.75; P=0.02) for those mainly requiring oxygen support of non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC). The time to IMV initiation was similar (mean 8.3 vs. 10.0 days; P=0.66) for patients requiring NIMV and HFNC. Patients mainly receiving supplemental oxygen and non-rebreather masks had improved oxygenation parameters, although not statistically significant. Other outcomes involving all-cause hospital mortality, hospital and ICU (intensive care unit) length of stay, and adverse events were comparable. APP appeared to be an important modality for reducing IMV requirements, especially in those requiring NIMV and HFNC.

Klíčová slova: COVID-19; Awake prone positioning; Prone positioning; Proning; Meta-analysis

Creative Commons License
Clinical Outcomes of Routine Awake Prone Positioning in COVID-19 Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials is licensed under a Creative Commons Attribution 4.0 International License.

167 x 240 mm
vychází: 4 x ročně
cena tištěného čísla: 450 Kč
ISSN: 1214-6994
E-ISSN: 2336-2936

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