The efficacy and tolerance of prone positioning in non-intubation patients with acute hypoxemic respiratory failure and ARDS: a meta-analysis

Autor: Wei Tan, Dong-yang Xu, Meng-jiao Xu, Zan-feng Wang, Bing Dai, Li-li Li, Hong-wen Zhao, Wei Wang, Jian Kang
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Therapeutic Advances in Respiratory Disease, Vol 15 (2021)
Druh dokumentu: article
ISSN: 1753-4666
17534666
DOI: 10.1177/17534666211009407
Popis: Background and aims: 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 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.
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