Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan 2;24(1):5.
doi: 10.1186/s12890-023-02829-2.

Effectiveness and safety of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure: an overview of systematic reviews

Ya Li  1   2 , Guixiang Zhao  1   2 , Yizhao Ma  1   2 , Lu Wang  1   2 , Ying Liu  1   2 , Hailong Zhang  3   4   5
Affiliations
Review

Effectiveness and safety of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure: an overview of systematic reviews

Ya Li et al. BMC Pulm Med. .

Abstract

Objective: To evaluate and summarize systematic reviews of the effects and safety of awake prone positioning for COVID-19-related acute hypoxaemic respiratory failure.

Methods: A comprehensive search was conducted on PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CSPD, CCD and CBM from their inception to March 28, 2023. Systematic reviews (SRs) of awake prone positioning (APP) for COVID-19-related acute hypoxaemic respiratory failure in adults were included. Two reviewers screened the eligible articles, and four reviewers in pairs extracted data and assessed the methodological quality/certainty of the evidence of all included SRs by AMSTAR 2 and GRADE tools. The overlap of primary studies was measured by calculating corrected covered areas. Data from the included reviews were synthesized with a narrative description.

Results: A total of 11 SRs were included. The methodological quality of SRs included 1 "High", 4 "Moderate", 2 "Low" and 4 "Critically low" by AMSTAR 2. With the GRADE system, no high-quality evidence was found, and only 14 outcomes provided moderate-quality evidence. Data synthesis of the included SR outcomes showed that APP reduced the risk of requiring intubation (11 SRs) and improving oxygenation (3 SRs), whereas reduced significant mortality was not found in RCT-based SRs. No significant difference was observed in the incidence of adverse events between groups (8 SRs). The corrected covered area index was 27%, which shows very high overlap among studies.

Conclusion: The available SRs suggest that APP has benefits in terms of reducing intubation rates and improving oxygenation for COVID-19-related acute hypoxemic respiratory failure, without an increased risk of adverse events. The conclusion should be treated with caution because of the generally low quality of methodology and evidence.

Trial registration: The protocol for this review was registered with PROSPERO: CRD42023400986. Registered 15 April 2023.

Keywords: Acute hypoxemic respiratory failure; Awake prone positioning; COVID-19.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study selection flowchart
Fig. 2
Fig. 2
Visualization of the pairwise CCA (%) with a heatmap
Fig. 3
Fig. 3
AMSTAR-2 evaluation included in systematic evaluation
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hu Y, Sun J, Dai Z, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Virol. 2020;127:104371. doi: 10.1016/j.jcv.2020.104371. - DOI - PMC - PubMed
    1. Tan E, Song J, Deane AM, et al. Global impact of coronavirus disease 2019 infection requiring admission to the ICU: a systematic review and Meta-analysis. Chest. 2021;159(2):524–536. doi: 10.1016/j.chest.2020.10.014. - DOI - PMC - PubMed
    1. Bellani G, Pham T, Laffey J. Incidence of Acute Respiratory Distress Syndrome--Reply. Jama. 2016;316(3):347. doi: 10.1001/jama.2016.6471. - DOI - PubMed
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–2168. doi: 10.1056/NEJMoa1214103. - DOI - PubMed