44
Views
0
CrossRef citations to date
0
Altmetric
Original Research

Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis

, , , , , , , , , , , , , , , , , , , & show all
Received 25 Nov 2023, Accepted 29 Apr 2024, Published online: 09 May 2024

References

  • WHO. Coronavirus disease (COVID-19) pandemic. [cited 2021 Jul 3]. Available from: www.who.int/emergencies/diseases/novel-coronavirus-2019
  • Maggi E, Canonica W, Moretta L. COVID-19: unanswered questions on immune response and pathogenesis. J Allergy Clin Immunol. 2020;146(1):18–22. doi: 10.1016/j.jaci.2020.05.001
  • Duan G, Yang H, Ji W. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses. 2020;12(4):372. doi: 10.3390/v12040372
  • Jeronimo CMP, Farias MEL, Val FFA, et al. Methylprednisolone as adjunctive therapy for patients hospitalized with coronavirus disease 2019 (COVID-19; metcovid): a randomized, double-blind, phase IIb, placebo-controlled trial. Clin Infect Dis. 2020;72(9):1–9.
  • Borba MGS, Val FFA, Sampaio VS, et al. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial. JAMA Netw Open. 2020;3(4):e208857. doi: 10.1001/jamanetworkopen.2020.8857
  • Scholten EL, Beitler JR, Prisk GK, et al. Treatment of ARDS with prone positioning. Chest. 2017;151(1):215–224. doi: 10.1016/j.chest.2016.06.032
  • Taboada M, Rodríguez N, Riveiro V, et al. Prone positioning in awake non-ICU patients with ARDS caused by COVID-19. Anaesth Crit Care Pain Med. 2020;39(5):581–583. doi: 10.1016/j.accpm.2020.08.002
  • Taboada M, González M, Álvarez A, et al. Effectiveness of prone positioning in non-intubated ICU patients with moderate to severe ARDS by COVID-19. Anesth Analg Publish Ah. 2020;132:1–6.
  • Munshi L, Del Sorbo L, Adhikari NKJ, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Supplement_4):S280–S288. doi: 10.1513/AnnalsATS.201704-343OT
  • Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097
  • World Bank. New world bank country classifications by income level: 2022-2023. [cited 2021 Aug 15]. Available from: https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2022-2023
  • Rosén J, von Oelreich E, Fors D, et al. Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial. Crit Care. 2021;25(1):209. doi: 10.1186/s13054-021-03602-9
  • Johnson SA, Horton DJ, Fuller MJ, et al. Patient-directed prone positioning in awake patients with COVID-19 requiring hospitalization (PAPR). Ann Am Thorac Soc. 2021;18(8):1424–1426. doi: 10.1513/AnnalsATS.202011-1466RL
  • Yarahmadi S, Ebrahimzadeh F, Mohamadipour F, et al. Effect of prone position on clinical outcomes of nonintubated patients with COVID-19: a randomised clinical trial. Collegian. 2023;30:449–456. doi: 10.1016/j.colegn.2022.12.005
  • Alhazzani W, Parhar KKS, Weatherald J, et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure. JAMA. 2022;327(21):2104. doi: 10.1001/jama.2022.7993
  • Padrão EMH, Valente FS, Besen BAMP, et al. Awake prone positioning in COVID‐19 hypoxemic respiratory failure: exploratory findings in a Single‐center retrospective cohort study. Acad Emerg Med. 2020;27(12):1249–1259. doi: 10.1111/acem.14160
  • Prud’homme E, Trigui Y, Elharrar X, et al. Effect of prone positioning on the respiratory support of nonintubated patients with COVID-19 and acute hypoxemic respiratory failure. Chest. 2021;160(1):85–88. doi: 10.1016/j.chest.2021.01.048
  • Jouffroy R, Darmon M, Isnard F, et al. Impact of prone position in non-intubated spontaneously breathing patients admitted to the ICU for severe acute respiratory failure due to COVID-19. J Crit Care. 2021;64:199–204. doi: 10.1016/j.jcrc.2021.04.014
  • Ferrando C, Mellado-Artigas R, Gea A, et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care. 2020;24(1):597. doi: 10.1186/s13054-020-03314-6
  • Bahloul M, Kharrat S, Hafdhi M, et al. Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing. Acute Critical Care. 2021;36(3):208–214. doi: 10.4266/acc.2021.00500
  • Jagan N, Morrow LE, Walters RW, et al. The POSITIONED study: prone positioning in nonventilated coronavirus disease 2019 patients—A retrospective analysis. Crit Care Explor. 2020;2(10):e0229. doi: 10.1097/CCE.0000000000000229
  • Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, et al. Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study. Eur Respir J. 2022;59(2):2100265. doi: 10.1183/13993003.00265-2021
  • Vianello A, Turrin M, Guarnieri G, et al. Prone positioning is safe and May reduce the rate of intubation in selected COVID-19 patients receiving high-flow nasal oxygen therapy. J Clin Med. 2021;10(15):3404. doi: 10.3390/jcm10153404
  • Esperatti M, Busico M, Fuentes NA, et al. Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study. Crit Care. 2022;26:16. doi: 10.1186/s13054-021-03881-2
  • Ehrmann S, Li J, Ibarra-Estrada M, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med. 2021;9(12):1387–1395. doi: 10.1016/S2213-2600(21)00356-8
  • Tonelli R, Pisani L, Tabbì L, et al. Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: a retrospective multicenter cohort study. Pulmonology. 2021;28(3):181–192. doi: 10.1016/j.pulmoe.2021.03.002
  • Zang X, Wang Q, Zhou H, et al. Efficacy of early prone position for COVID-19 patients with severe hypoxia: a single-center prospective cohort study. Intensive Care Med. 2020;46(10):1927–1929. doi: 10.1007/s00134-020-06182-4
  • Loureiro-Amigo J, Suárez-Carantoña C, Oriol I, et al. Prone position in COVID-19 patients with severe acute respiratory distress syndrome receiving conventional oxygen therapy: a retrospective study. Arch Bronconeumol. 2021;58:19–21.
  • Lamm WJE, Graham MM, Albert RK. Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med. 1994;150(1):184–193. doi: 10.1164/ajrccm.150.1.8025748
  • Mutoh T, Guest RJ, Lamm WJE, et al. Prone position alters the effect of volume overload on regional pleural pressures and improves hypoxemia in pigs in vivo. Am Rev Respir Dis. 1992;146(2):300–306. doi: 10.1164/ajrccm/146.2.300
  • Cortney Henderson A, Sá RC, Theilmann RJ, et al. The gravitational distribution of ventilation-perfusion ratio is more uniform in prone than supine posture in the normal human lung. J Appl Physiol. 2013;115(3):313–324. doi: 10.1152/japplphysiol.01531.2012
  • Sryma P, Mittal S, Mohan A, et al. Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy. Lung India. 2021;38(7):6. doi: 10.4103/lungindia.lungindia_794_20
  • Pierucci P, Ambrosino N, Di Lecce V, et al. Prolonged active prone positioning in spontaneously breathing non-intubated patients with COVID-19-Associated hypoxemic acute respiratory failure with PaO2/FiO2 >150. Front Med. 2021;8:1–8. doi: 10.3389/fmed.2021.626321
  • Vetrugno L, Castaldo N, Fantin A, et al. Ventilatory associated barotrauma in COVID-19 patients: a multicenter observational case control study (COVI-MIX-study). Pulmonology. 2023;29(6):457–468. doi: 10.1016/j.pulmoe.2022.11.002
  • Kangelaris KN, Ware LB, Wang CY, et al. Timing of intubation and clinical outcomes in adults with ARDS*. Crit Care Med. 2016;44(1):120–129. doi: 10.1097/CCM.0000000000001359
  • Hraiech S, Alingrin J, Dizier S, et al. Time to intubation is associated with outcome in patients with community-acquired pneumonia. PLOS ONE. 2013;8(9):e74937. doi: 10.1371/journal.pone.0074937
  • Liu X, Liu H, Lan Q, et al. Early prone positioning therapy for patients with mild COVID-19 disease. Medicina Clínica. 2021;156(8):386–389. doi: 10.1016/j.medcli.2020.11.036
  • Coppo A, Bellani G, Winterton D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med. 2020;8(8):765–774. doi: 10.1016/S2213-2600(20)30268-X
  • Barker J, Pan D, Koeckerling D, et al. Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19. Postgrad Med J. 2021;98(1159):360–364. doi: 10.1136/postgradmedj-2020-139631
  • Kharat A, Dupuis-Lozeron E, Cantero C, et al. Self-proning in COVID-19 patients on low-flow oxygen therapy: a cluster randomised controlled trial. ERJ Open Res. 2021;7(1):00692–02020. doi: 10.1183/23120541.00692-2020
  • Gad GS. Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure. Egypt J Anaesth. 2021;37(1):85–90. doi: 10.1080/11101849.2021.1889944
  • Ripoll-Gallardo A, Grillenzoni L, Bollon J, et al. Prone positioning in non-intubated patients with COVID-19 outside of the intensive care unit: more evidence needed. Disaster Med Public Health Prep. 2020;14(4):e22–e24. doi: 10.1017/dmp.2020.267
  • Singh P, Jain P, Deewan H. Awake prone positioning in COVID-19 patients. Indian J Crit Care Med. 2020;24:914–918. doi: 10.5005/jp-journals-10071-23546
  • Paternoster G, Sartini C, Pennacchio E, et al. Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: a case series. Med Intensiva. 2022;46(2):65–71. doi: 10.1016/j.medin.2020.08.008
  • Sartini C, Tresoldi M, Scarpellini P, et al. Respiratory parameters in patients with COVID-19 after using noninvasive ventilation in the prone position outside the intensive care unit. JAMA. 2020;323(22):2338. doi: 10.1001/jama.2020.7861
  • Simioli F, Annunziata A, Langella G, et al. Early prone positioning and non-invasive ventilation in a critical COVID-19 subset. A single centre experience in southern Italy. Turk Thorac J. 2021;22(1):57–61. doi: 10.5152/TurkThoracJ.2021.20158
  • Wormser J, Romanet C, Philippart F. Prone position in wards for spontaneous breathing covid-19 patients: a retrospective study. Ir J Med Sci. 2021;190(4):1519–1522. doi: 10.1007/s11845-020-02479-x
  • Elharrar X, Trigui Y, Dols A-M, et al. Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA. 2020;323(22):2336. doi: 10.1001/jama.2020.8255
  • Tu G-W, Liao Y-X, Li Q-Y, et al. Prone positioning in high-flow nasal cannula for COVID-19 patients with severe hypoxemia: a pilot study. Ann Transl Med. 2020;8(9):598–598. doi: 10.21037/atm-20-3005
  • Caputo ND, Strayer RJ, Levitan R, et al. Early self-proning in awake, non-intubated patients in the emergency department: a single ED’s experience during the COVID-19 pandemic. Acad Emerg Med. 2020;27(5):375–378. doi: 10.1111/acem.13994
  • Xu Q, Wang T, Qin X, et al. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care. 2020;24(1):250. doi: 10.1186/s13054-020-02991-7
  • Taboada M, Rodríguez N, Riveiro V, et al. Short-term outcomes of 50 patients with acute respiratory distress by COVID-19 where prone positioning was used outside the ICU. J Clin Anesth. 2020;67:110028. doi: 10.1016/j.jclinane.2020.110028
  • Taboada M, González M, Álvarez A, et al. Effectiveness of prone positioning in nonintubated intensive care unit patients with moderate to severe acute respiratory distress syndrome by coronavirus disease 2019. Anesth Analg. 2021;132(1):25–30. doi: 10.1213/ANE.0000000000005239
  • Winearls S, Swingwood EL, Hardaker CL, et al. Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: a retrospective analysis. BMJ Open Respir Res. 2020;7(1):e000711. doi: 10.1136/bmjresp-2020-000711
  • Dubosh NM, Wong ML, Grossestreuer AV, et al. Early, awake proning in emergency department patients with COVID-19. Am J Emerg Med. 2021;46:640–645. doi: 10.1016/j.ajem.2020.11.074
  • Khanum I, Samar F, Fatimah Y, et al. Role of awake prone positioning in patients with moderate-to-severe COVID-19: an experience from a developing country. Monaldi Arch Chest Dis. 2021;91(2). doi: 10.4081/monaldi.2021.1561
  • Jha A, Chen F, Mann S, et al. Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge. ERJ Open Res. 2022;8(1):00524–02021. doi: 10.1183/23120541.00524-2021
  • Silva JM, Treml RE, Golinelli PC, et al. Response of patients with acute respiratory failure caused by COVID-19 to awake-prone position outside the intensive care unit based on pulmonary involvement. Clinics. 2021;76:1–10. doi: 10.6061/clinics/2021/e3368
  • Chong Y, Nan C, Mu W, et al. Effects of prone and lateral positioning alternate in high-flow nasal cannula patients with severe COVID-19. Crit Care. 2022;26(1):26–28. doi: 10.1186/s13054-022-03897-2
  • Yildiz M, Ozturk Ergur F, Uzel Senel M, et al. The use of prone positioning in severe COVID-19 outside the intensive care unit. Bratisl Med J. 2021;122(8):590–593. doi: 10.4149/BLL_2021_094
  • Man M-Y, Lam S-M, Shum H-P, et al. Prone positioning in non-intubated patients with coronavirus – a single-centre experience in Hong Kong. Hong Kong J Emerg Med. 2021;28(6):379–382. doi: 10.1177/10249079211022914
  • Chiumello D, Chiodaroli E, Coppola S, et al. Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP. Ann Intensive Care. 2021;11(1). doi: 10.1186/s13613-021-00967-6
  • Behesht Aeen F, Pakzad R, Goudarzi Rad M, et al. Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis. Sci Rep. 2021;11(1):1–16. doi: 10.1038/s41598-021-93739-y
  • Ponnapa Reddy M, Subramaniam A, Afroz A, et al. Prone positioning of nonintubated patients with coronavirus disease 2019—a systematic review and meta-analysis. Crit Care Med Publish Ah. 2021;49(10):e1001–e1014. doi: 10.1097/CCM.0000000000005086
  • Sryma PB, Mittal S, Madan K, et al. Awake prone positioning in non-intubated patients for the management of hypoxemia in COVID-19: a systematic review and meta-analysis. Monaldi Arch Chest Dis. 2021;91(2). doi: 10.4081/monaldi.2021.1623
  • Cardona S, Downing J, Alfalasi R, et al. Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: a meta-analysis. Am J Emerg Med. 2021;43:88–96. doi: 10.1016/j.ajem.2021.01.058
  • Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med. 2022;2600(6):7–9. doi: 10.1016/S2213-2600(22)00164-3
  • Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive care Med. 2023;49(7):727–759. doi: 10.1007/s00134-023-07050-7
  • Wildman J. COVID-19 and income inequality in OECD countries. Eur J Health Econ. 2021;22(3):455–462. doi: 10.1007/s10198-021-01266-4
  • Kondo N, Sembajwe G, Kawachi I, et al. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ. 2009;339(nov10 2):b4471–b4471. doi: 10.1136/bmj.b4471

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.