Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis

The Application of Awake-Prone Positioning Among Non-intubated Patients With COVID-19-Related ARDS: A Narrative Review

“…Sustaining the awake-prone position for an extended period may correlate with improvements in oxygenation levels, whereas the benefits of very short sessions may be questionable. The latest meta-analysis illustrated that prone positioning can improve the oxygenation level amongst non-intubated patients with acute hypoxemic respiratory failure when applied for at least 4 h daily (48). Most studies (Supplementary Table 1) applied the protocol of proning for either ≥3 h twice daily, 10-12 h, or more than 16 h (29, 31-35, 37, 39, 49-52).…”

Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis

“… 11 However, before this publication, six randomised controlled trials (RCTs) with a smaller sample size than the meta-trial, 12 , 13 , 14 , 15 , 16 , 17 and two completed but unpublished multi-centre RCTs that enrolled 248 patients 18 and 293 patients, 19 respectively, did not find that awake prone positioning reduced the intubation need for patients with COVID-19; and, three RCTs 12 , 13 , 18 found that patients' adherence to awake prone positioning was low. In the two most recent meta-analyses that included RCTs, 20 , 21 Fazzini and colleagues included two RCTs 11 , 14 and 12 observational studies, and they reported uncertainty regarding the effects of awake prone positioning on intubation and survival, 20 whereas Beran and colleagues included five RCTs 11 , 12 , 13 , 14 , 16 and nine observational studies, and they reported that awake prone positioning has a benefit on mortality. 21 …”

Breathing face down

“…Firstly, the prone position has been proved to improve oxygenation in mechanically ventilated patients with ARDS, 8 but it must be applied for prolonged periods of time (at least 16 h) to improve the P a O 2 /FiO 2 ratio in severely hypoxaemic patients. 9 This review shows a significant improvement of the P a O 2 /FiO 2 ratio of –3.5 when patients received awake prone ventilation. A subgroup analysis showed significant improvement when patients maintained the prone position for more than 4 h, although they could not conclude if the duration of pronation was cumulative or consecutive.…”