Association of Awake Prone Positioning With Intubation Risk and Mortality in Non-Intubated Patients With COVID-19 Respiratory Failure: A Systemic Review and Meta-Analysis

Abstract

Background:

Awake prone positioning (APP) is widely used in non-intubated patients with COVID-19 respiratory failure. The primary reported beneficial effects of APP are improving oxygenation, avoiding endotracheal intubation, and improving survival. However, the results are inconsistent.

Methods:

We performed a systemic review and meta-analyses to quantify APP’s impacts on intubation rate and mortality on non-intubated respiratory failure patients with COVID-19 compared to usual care. We calculated and pooled the risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model. Statistical heterogeneities were reported through the use of I² statistics.

Results:

We searched and retrieved all relevant randomized control trials and observational studies identified in Web of Science, PubMed, and EMBASE. The search cut-off date was March 18, 2022. Six studies involving 1,404 non-intubated patients receiving APP and 1,319 non-intubated patients receiving usual care that met our selection criteria were identified and analyzed. We found that in non-intubated patients receiving APP, intubation was 0.22-fold less likely to be intubated than patients receiving usual care. However, it did not reach a statistically significant level (RR = 0.78, 95% CI = 0.58-1.03, I² = 85%). We also found that the RR of mortality among non-intubated patients receiving APP was significantly lower than patients receiving usual care (RR = 0.68, 95% CI = 0.49-0.93, I² = 70%).

Conclusions:

In non-intubated COVID-19 respiratory failure patients, APP was associated with a modestly lower risk of intubation and a moderately lower risk of mortality than usual care.