Is Prone Positioning Effective in Improving Hypoxemia for Nonventilated Patients With Covid-19? A Rapid Evidence Assessment

Abstract

Purpose: A relatively high percentage of patients with COVID-19 develop hypoxemia and must be mechanically ventilated. Although prone positioning (PP) has been shown to be effective in improving peripheral oxygen saturation (SpO2) in mechanically ventilated patients with hypoxemia, whether it is effective in nonventilated patients with COVID-19 is not known. The purpose of this rapid evidence assessment was to examine the effectiveness of PP on SpO2 for nonventilated adults with COVID-19 and hypoxemia. Methods: The PEDro, Medline Complete, and Cochrane Central Register of Controlled Trials databases were searched. The inclusion criteria included nonventilated adults, diagnosed with COVID-19, and treated with PP. The exclusion criteria included patients on mechanical ventilation and <18 years old. The primary outcome was SpO2, and secondary outcomes included PaO2 and PaO2/FiO2 ratio. The methodologic quality was appraised using the Scottish Intercollegiate Guidelines Network Methodology Checklist 3. Results: Eight studies met all inclusion/exclusion criteria, and a total of 199 patients were included. All studies were cohort or retrospective design, and 4 of 8 met the acceptable threshold for risk of bias. All 5 of the studies that reported SpO2 found an increase in post-PP compared with pre-PP, and 5 studies found that PaO2, PaO2/FiO2, or both increased post-PP compared with pre-PP. Conclusions: Owing to heterogeneity in methods and outcomes, as well as varied results, we conclude there is low–moderate support that PP improves SpO2 and other indicators of hypoxemia in nonventilated patients with COVID-19, but not all patients may benefit. In addition, well-controlled studies are needed to confirm these results.