In:
Therapeutic Advances in Respiratory Disease, SAGE Publications, Vol. 15 ( 2021-01), p. 175346662110094-
Abstract:
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, I 2 = 25%], 4% (95% CI: 0.01–0.07, I 2 = 0%), respectively, and the intolerance rate was 7% (95% CI: 0.01–0.12, I 2 = 5%). Prone positioning increased PaO 2 /FiO 2 [mean difference (MD) = 47.89, 95% CI: 28.12–67.66; p 〈 0.00001, I 2 = 67%] and SpO 2 (MD = 4.58, 95% CI: 1.35–7.80, p = 0.005, I 2 = 97%), whereas it reduced respiratory rate (MD = −5.01, 95% CI: −8.49 to −1.52, p = 0.005, I 2 = 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. PaO 2 /FiO 2 and SpO 2 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.
Type of Medium:
Online Resource
ISSN:
1753-4666
,
1753-4666
DOI:
10.1177/17534666211009407
Language:
English
Publisher:
SAGE Publications
Publication Date:
2021
detail.hit.zdb_id:
2387506-9
Permalink
