Efficacy of early prone position for COVID-19 patients with severe hypoxia: a single-center prospective cohort study

Zang, Xuefeng; Wang, Qian; Zhou, Hua; Liu, Sanhong; Xue, Xinying; Zhang, Weidong; Gao, Quansheng; Xie, Jiang; Jiang, Chunguo; Ding, Xiaoyan; Zhang, Jie; Lu, Feiping; Chen, Wei; Zhang, Jie; He, Ping; Zhu, Meng-Yang; Zhang, Xiaomeng; Yuan, Xiaodong; Tian, Rong; Wang, Xiaohui; Zhang, Nan; Guo, Jun; Zang, Xuelei; Ma, Xidong; Xue, Zhiqiang

doi:10.1007/s00134-020-06182-4

Cited by 71 publications

(140 citation statements)

References 4 publications

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“…Reduction of respiratory rate with APP was demonstrated in ve studies (n = 90) [10,28,36,40,41], but not in two other studies (n = 34) [33,45]. Finally, signi cantly reduced PaCO2 was demonstrated only in a single small study (n = 9) [35], while no changes in PaCO2 were observed in a larger report (n = 46) [14].…”

Section: Resultsmentioning

confidence: 81%

Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis

Pavlov¹,

McNicholas

et al. 2020

Preprint

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Background: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubations of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP. Methods: We performed a prospective systematic review and meta-analysis of observational studies to compare in-hospital intubation and mortality rates in patients treated with APP or with standard care.Results: A total of 46 published and 4 unpublished observational studies that included 2994 patients were included. The intubation rate was 27% (95%CI, 19 to 37%) in the 870 patients treated with APP, as compared to 30% (95%CI, 20 to 42%) in the 852 patients treated with usual care (p=0.71). The mortality rate was 11% (95CI%, 6 to 20%) in the 767 patients treated with APP, as compared to 22% (95%CI, 13 to 36%) in those treated with usual care. This difference was not statistically significant (p=0.10). APP was associated with significant improvement of various oxygenation parameters in 19 studies (n=381) that reported this outcome.Conclusions: In this prospective meta-analysis of observational studies of patients with acute hypoxemic respiratory failure due to COVID-19, APP did not result in lower intubation or mortality rates, despite reported improvements in oxygenation parameters. Data from randomized controlled trials are needed. Routine implementation of APP outside of a clinical trial is not supported by current evidence. Registered on PROSPERO on August 3d, 2020, CRD42020201947.

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Section: Resultsmentioning

confidence: 81%

Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis

Pavlov¹,

McNicholas

et al. 2020

Preprint

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“…Finally, an important limitation not mentioned by the authors is the possibility of methodological bias since the method in which patients were allocated to the groups was not described. Although we recognize the importance of the study by Zang et al [1], we hope that results from ongoing randomized controlled trials (e.g., NCT04383613, NCT04359797, NCT04350723, NCT04347941, NCT04477655 and NCT04344587) demonstrate greater certainty about the effects of the early prone position in non-intubated COVID-19 patients with hypoxia on intubation and mortality rates.…”

Section: Dear Editormentioning

confidence: 90%

“…We have read with interest the study by Zang et al [1] recently published in Intensive Care Medicine, which showed greater 90-day survival in the group of nonintubated COVID-19 patients with severe hypoxia who performed early prone position (56.5%) compared to the group who did not (24.3%). This result is an important differential in relation to the several studies previously published.…”

Section: Dear Editormentioning

confidence: 96%

“…Although there is not a significant difference, we found in Table S3 [1] that a greater number of patients in the early prone position group required invasive mechanical ventilation (34.8%) when compared to the non-prone position group (10.8%). However, what draws the most attention is that many patients who died in the non-prone position group did not receive invasive mechanical ventilation (Table S2-88.9%) [1]. What is the explanation for that?…”

Section: Dear Editormentioning

confidence: 99%

“…Thus, the authors suggested the application of early prone position especially in patients with moderate ARDS and baseline SpO 2 > 95%. Controversially, the patients selected by Zang et al [1] had severe hypoxia.…”

Section: Dear Editormentioning

confidence: 99%

See 2 more Smart Citations

Early prone position for COVID-19 patients with severe hypoxia: reduces the mortality but increases the intubation risk?

Gulart

Silva

2020

Intensive Care Med

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Lungensonographie bei COVID‑19

et al. 2020

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Die medizinische Versorgung von Patienten, die im Zusammenhang mit der pandemischen Coronaviruserkrankung 2019 („coronavirus disease 2019“, COVID-19) erkrankt sind, stellt für die staatlichen Gesundheitssysteme weltweit eine große Herausforderung dar. Das Virus mit dem Namen „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) zeigt eine hohe Organspezifität zu den unteren Atemwegen. Da bislang weder eine wirksame Therapie noch Impfung gegen das Virus existieren, kommt der diagnostischen Früherkennung eine große Bedeutung zu. Durch den spezifischen Aspekt der überwiegend im peripheren Lungenparenchym beginnenden Infektion ist die Lungensonographie als bildgebende Diagnostikmethode geeignet, Verdachtsfälle bereits im Frühstadium der Erkrankung als solche zu identifizieren. Serielle Ultraschalluntersuchungen an Patienten mit bestätigter Infektion können bettseitig und zeitnah Veränderungen im betroffenen Lungengewebe nachweisen. Dieser Artikel fasst das diagnostische Potenzial der Lungensonographie im Hinblick auf Screening und therapeutische Entscheidungsfindung bei Patienten mit vermuteter oder bestätigter SARS-CoV-2-Pneumonie zusammen.

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Efficacy of early prone position for COVID-19 patients with severe hypoxia: a single-center prospective cohort study

Cited by 71 publications

References 4 publications

Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis

Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis

Early prone position for COVID-19 patients with severe hypoxia: reduces the mortality but increases the intubation risk?

Lungensonographie bei COVID‑19

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