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Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials

Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of A...

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Autores principales: Cheema, Huzaifa Ahmad, Siddiqui, Amna, Ochani, Sidhant, Adnan, Alishba, Sukaina, Mahnoor, Haider, Ramsha, Shahid, Abia, Rehman, Mohammad Ebad Ur, Awan, Rehmat Ullah, Singh, Harpreet, Duric, Natalie, Fazzini, Brigitta, Torres, Antoni, Szakmany, Tamas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917863/
https://www.ncbi.nlm.nih.gov/pubmed/36769574
http://dx.doi.org/10.3390/jcm12030926
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author Cheema, Huzaifa Ahmad
Siddiqui, Amna
Ochani, Sidhant
Adnan, Alishba
Sukaina, Mahnoor
Haider, Ramsha
Shahid, Abia
Rehman, Mohammad Ebad Ur
Awan, Rehmat Ullah
Singh, Harpreet
Duric, Natalie
Fazzini, Brigitta
Torres, Antoni
Szakmany, Tamas
author_facet Cheema, Huzaifa Ahmad
Siddiqui, Amna
Ochani, Sidhant
Adnan, Alishba
Sukaina, Mahnoor
Haider, Ramsha
Shahid, Abia
Rehman, Mohammad Ebad Ur
Awan, Rehmat Ullah
Singh, Harpreet
Duric, Natalie
Fazzini, Brigitta
Torres, Antoni
Szakmany, Tamas
author_sort Cheema, Huzaifa Ahmad
collection PubMed
description Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74–0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77–1.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.
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spelling pubmed-99178632023-02-11 Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials Cheema, Huzaifa Ahmad Siddiqui, Amna Ochani, Sidhant Adnan, Alishba Sukaina, Mahnoor Haider, Ramsha Shahid, Abia Rehman, Mohammad Ebad Ur Awan, Rehmat Ullah Singh, Harpreet Duric, Natalie Fazzini, Brigitta Torres, Antoni Szakmany, Tamas J Clin Med Systematic Review Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74–0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77–1.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment. MDPI 2023-01-25 /pmc/articles/PMC9917863/ /pubmed/36769574 http://dx.doi.org/10.3390/jcm12030926 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Cheema, Huzaifa Ahmad
Siddiqui, Amna
Ochani, Sidhant
Adnan, Alishba
Sukaina, Mahnoor
Haider, Ramsha
Shahid, Abia
Rehman, Mohammad Ebad Ur
Awan, Rehmat Ullah
Singh, Harpreet
Duric, Natalie
Fazzini, Brigitta
Torres, Antoni
Szakmany, Tamas
Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title_full Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title_fullStr Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title_full_unstemmed Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title_short Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
title_sort awake prone positioning for non-intubated covid-19 patients with acute respiratory failure: a meta-analysis of randomised controlled trials
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917863/
https://www.ncbi.nlm.nih.gov/pubmed/36769574
http://dx.doi.org/10.3390/jcm12030926
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