Abstract
Prone position (PP) is known to improve oxygenation and reduce mortality in COVID-19 patients. This systematic review and meta-analysis aimed to determine the effects of PP on respiratory parameters and outcomes. PubMed, EMBASE, ProQuest, SCOPUS, Web of Sciences, Cochrane library, and Google Scholar were searched up to 1st January 2021. Twenty-eight studies were included. The Cochran's Q-test and I2 statistic were assessed heterogeneity, the random-effects model was estimated the pooled mean difference (PMD), and a meta-regression method has utilized the factors affecting heterogeneity between studies. PMD with 95% confidence interval (CI) of PaO2/FIO2 Ratio in before–after design, quasi-experimental design and in overall was 55.74, 56.38, and 56.20 mmHg. These values for Spo2 (Sao2) were 3.38, 17.03, and 7.58. PP in COVID-19 patients lead to significantly decrease of the Paco2 (PMD: − 8.69; 95% CI − 14.69 to − 2.69 mmHg) but significantly increase the PaO2 (PMD: 37.74; 95% CI 7.16–68.33 mmHg). PP has no significant effect on the respiratory rate. Based on meta-regression, the study design has a significant effect on the heterogeneity of Spo2 (Sao2) (Coefficient: 12.80; p < 0.001). No significant associations were observed for other respiratory parameters with sample size and study design. The pooled estimate for death rate and intubation rates were 19.03 (8.19–32.61) and 30.68 (21.39–40.75). The prone positioning was associated with improved oxygenation parameters and reduced mortality and intubation rate in COVID-19 related respiratory failure.
Highlights
Prone position (PP) is known to improve oxygenation and reduce mortality in COVID-19 patients
Considering that COVID-19 is a novel disease that caused many difficulties and due to lack of sufficient evidence, the need to assess the effects of prone positioning as a supportive care in hypoxemic patients is necessary, so we conducted this systematic review and meta-analysis to determine the effects of prone position on respiratory parameters and outcomes of COVID-19 patients
In our systematic review of 28 studies, prone positioning has been compared with supine positioning in hypoxic adult patients with COVID-19
Summary
Prone position (PP) is known to improve oxygenation and reduce mortality in COVID-19 patients. The prone positioning was associated with improved oxygenation parameters and reduced mortality and intubation rate in COVID-19 related respiratory failure. Prone positioning is one of these interventions for patients with severe ARDS, which could improve oxygenation and has a survival benefit and could improve outcomes in COVID-19 patients It has been suggested as the standard of care in international guidelines. Intubated patients in prone positioning are at risk, such as accidental removal of the tracheal tube, pressure ulcer, facial edema, gastroesophageal reflux, and other problems Overall, it seems that correct patient selection, timely initiation, and duration of patient’s placement in this position can all affect the effectiveness of this intervention. Considering that COVID-19 is a novel disease that caused many difficulties and due to lack of sufficient evidence, the need to assess the effects of prone positioning as a supportive care in hypoxemic patients is necessary, so we conducted this systematic review and meta-analysis to determine the effects of prone position on respiratory parameters and outcomes of COVID-19 patients
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