Review
Effect of awake prone positioning in COVID-19 patients- A systematic review

https://doi.org/10.1016/j.tacc.2020.09.008Get rights and content

Abstract

Background

Prone positioning is known to reduce mortality in intubated non-COVID-19 patients suffering from moderate to severe acute respiratory distress syndrome (ARDS). However, studies highlighting the effect of awake proning in COVID-19 patients are lacking. We aim to conduct a systematic review of the available literature to highlight the effect of awake proning on the need for intubation, improvement in oxygenation and mortality rates in COVID-19 patients with ARDS.

Method

– A systematic search of 2 medical databases (PubMed, Google Scholar) was performed until July 5, 2020. Thirteen studies fulfilled the inclusion criteria, and 210 patients were included for the final analysis.

Result

–Majority of the patients were above 50 years of age with a male gender predominance (69%). Face mask (26%) was the most common interface used for oxygen therapy. The intubation and mortality rates were 23.80% (50/210) and 5.41% (5/203) respectively. Awake proning resulted in improvement in oxygenation (reported by 11/13 studies): improvement in SpO2, P/F ratio, PO2 and SaO2 reported by 7/13 (54%), 5/13 (38%), 2/13 (15%) and 1/13 (8%) of the studies. No major complications associated with prone positioning were reported by the included studies.

Conclusion

Awake prone positioning demonstrated an improvement in oxygenation of the patients suffering from COVID-19 related respiratory disease. Need for intubation was observed in less than 30% of the patients. Thus, we recommend early and frequent proning in patients suffering from COVID-19 associated ARDS, however, randomized controlled trials are needed before any definite conclusions are drawn.

Keywords

COVID-19
Prone positioning
Non-intubated
Prevention
Respiratory failure

Abbreviations

ARDS
acute respiratory distress syndrome
PP
prone positioning
CPAP
continuous positive airway pressure
HFNO
high flow nasal oxygen
COT
conventional oxygen therapy
HFNC
high flow nasal cannula
NIV
noninvasive ventilation
ICU
intensive care unit

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