Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials
17 trials (2931 patients) were included in the systematic review
• Awake prone positioning was found to reduce the risk of endotracheal intubation compared with usual care
• This translates to 55 fewer intubations per 1000 patients
• Awake prone positioning did not significantly affect secondary outcomes, including mortality, ventilator-free days, ICU length of stay, hospital length of stay, and escalation of oxygen modality
• Adverse events related to awake prone positioning were uncommon.
The reduction in intubation was driven mainly by trials that achieved longer duration of prone positioning (median ≥5 hours per day), targeted patients with more severe hypoxaemia (median peripheral oxygen saturation to fraction of inspired oxygen ratio <150), and focused on patients requiring high flow oxygen or non-invasive ventilation.