Abstract
Background
Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease’s novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP.
Methods
We searched PubMed, Embase, and Scopus databases through August 15, 2020 to identify relevant randomized control trials, observational studies, and case series. We performed random-effects meta-analyses for the primary outcome of intubation rate. We used moderator analysis and meta-regressions to assess sources of heterogeneity. We used the standard and modified Newcastle-Ottawa Scales (NOS) to assess studies’ quality.
Results
Our search identified 1043 articles. We included 16 studies from the original search and 2 in-press as of October 2020 in our analysis. All were observational studies. Our analysis included 364 patients; mean age was 56.8 (SD 7.12) years, and 68% were men. The intubation rate was 28% (95% CI 20%–38%, I2 = 63%). The mortality rate among patients who underwent awake PP was 14% (95% CI 7.4%–24.4%). Potential sources of heterogeneity were study design and setting (practice and geographic).
Conclusions
Our study demonstrated an intubation rate of 28% among hypoxic patients with COVID-19 who underwent awake PP. Awake PP in COVID-19 is feasible and practical, and more rigorous research is needed to confirm this promising intervention.
【저자키워드】 COVID-19, coronavirus, Noninvasive ventilation, intubation, Awake proning, prone positioning, 【초록키워드】 Meta-analysis, Evolution, Efficacy, oxygen, Intervention, database, heterogeneity, observational studies, meta-regression, Case series, Research, Patient, Study design, age, mortality rate, Randomized control trials, Analysis, noninvasive, ventilatory support, Treatment strategies, Newcastle-Ottawa Scale, Primary outcome, Random-effects meta-analysis, 95% CI, intubation rate, proning, Moderator analysis, men, articles, Result, identify, performed, the disease, conducted, searched, demonstrated, feasible, Potential, hypoxic patient, NOS, patients with COVID-19, with COVID-19, 【제목키워드】 Meta-analysis, hypoxia, Patient, treated,