Project description:BackgroundAwake-prone positioning was widely used in COVID-19, combined with high-flow nasal oxygen therapy or noninvasive ventilation, effectively reducing intubation, and the effect on mortality is controversial. We aim to reevaluate the efficacy of awake-prone positioning in COVID-19 and summarize the protocol for awake-prone positioning.MethodsWe gathered data on the treatment of COVID-19 using awake-prone positioning from Web of Science, Cochrane Library, Embase, PubMed, and CNKI. All the included studies were published between 2019 and 2023. Two researchers used the Assessment of Multiple Systematic Reviews tool to assess the methodological quality of the literature. The evidence was assessed using the Grading of Recommendations Assessment and Evaluation system.ResultsThirteen articles were included. The quality assessment using AMSTAR2 revealed that 3 articles were high quality, and 4 were moderate quality. The evidence quality assessment of 41 primary outcomes by the Grading of Recommendations Assessment, Development and Evaluation indicates that 9 indicators were of moderate quality, 21 were of low quality, and 6 were of very low quality.ConclusionsThe review demonstrates high methodological quality, but the evidence quality of its outcome indicators is low. Awake-prone position has been shown to decrease intubation and improve oxygenation in COVID-19 patients. It is recommended to consult the latest quality assessment standards to develop more rigorous experimental protocols, improve research quality, and facilitate the translation of research findings.

| S-EPMC11835137 | biostudies-literature

Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives.

Project description:Prone positioning reduces mortality in the management of intubated patients with moderate-to-severe acute respiratory distress syndrome. It allows improvement in oxygenation by improving ventilation/perfusion ratio mismatching.Because of its positive physiological effects, prone positioning has also been tested in non-intubated, spontaneously breathing patients, or "awake" prone positioning. This review provides an update on awake prone positioning for hypoxaemic respiratory failure, in both coronavirus disease 2019 (COVID-19) and non-COVID-19 patients. In non-COVID-19 acute respiratory failure, studies are limited to a few small nonrandomised studies and involved patients with different diseases. However, results have been appealing with regard to oxygenation improvement, especially when combined with noninvasive ventilation or high-flow nasal cannula.The recent COVID-19 pandemic has led to a major increase in hospitalisations for acute respiratory failure. Awake prone positioning has been used with the aim to prevent intensive care unit admission and mechanical ventilation. Prone positioning in conscious, non-intubated COVID-19 patients is used in emergency departments, medical wards and intensive care units.Several trials reported an improvement in oxygenation and respiratory rate during prone positioning, but impacts on clinical outcomes, particularly on intubation rates and survival, remain unclear. Tolerance of prolonged prone positioning is an issue. Larger controlled, randomised studies are underway to provide results concerning clinical benefit and define optimised prone positioning regimens.

| S-EPMC8112009 | biostudies-literature

Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients.

Project description: Not available

| S-EPMC7251246 | biostudies-literature

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review.

Project description: Not available

| S-EPMC7450241 | biostudies-literature

Effect of awake prone positioning in COVID-19 patients- A systematic review

Project description:Background Prone positioning is known to reduce mortality in intubated non-COVID-19 patients suffering from moderate to severe acute respiratory distress syndrome (ARDS). However, studies highlighting the effect of awake proning in COVID-19 patients are lacking. We aim to conduct a systematic review of the available literature to highlight the effect of awake proning on the need for intubation, improvement in oxygenation and mortality rates in COVID-19 patients with ARDS. Method – A systematic search of 2 medical databases (PubMed, Google Scholar) was performed until July 5, 2020. Thirteen studies fulfilled the inclusion criteria, and 210 patients were included for the final analysis. Result –Majority of the patients were above 50 years of age with a male gender predominance (69%). Face mask (26%) was the most common interface used for oxygen therapy. The intubation and mortality rates were 23.80% (50/210) and 5.41% (5/203) respectively. Awake proning resulted in improvement in oxygenation (reported by 11/13 studies): improvement in SpO2, P/F ratio, PO2 and SaO2 reported by 7/13 (54%), 5/13 (38%), 2/13 (15%) and 1/13 (8%) of the studies. No major complications associated with prone positioning were reported by the included studies. Conclusion Awake prone positioning demonstrated an improvement in oxygenation of the patients suffering from COVID-19 related respiratory disease. Need for intubation was observed in less than 30% of the patients. Thus, we recommend early and frequent proning in patients suffering from COVID-19 associated ARDS, however, randomized controlled trials are needed before any definite conclusions are drawn.

| S-EPMC7521914 | biostudies-literature

Early versus late awake prone positioning in non-intubated patients with COVID-19.

Project description:BackgroundAwake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP.MethodsPost hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate.ResultsWe included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8-12.82) vs 36.35 (30.2-75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0-9.05) and 3.0 (1.09-5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0-1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77-40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0-1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23-31.1], p = 0.027) were associated with increased mortality.ConclusionsEarly initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.

| S-EPMC8446738 | biostudies-literature

Awake prone positioning for patients with COVID-19-induced acute hypoxemic respiratory failure

Project description:Whereas prone positioning of intubated patients suffering from acute respiratory distress syndrome represents the standard of care, proning non-intubated patients, so-called “awake prone positioning (APP),” has only recently gained popularity and undergone scientific evaluation. In this review, we summarize current evidence on physiological and clinical effects of APP on patients' centered outcomes, such as intubation and mortality, the safety of the technique, factors and predictors of success, practical issues for optimal implementation, and future areas of research. Current evidence supports using APP among patients suffering from acute hypoxemic respiratory failure due to COVID-19 and undergoing advanced respiratory support, such as high-flow nasal cannula, in an intensive care unit setting. Healthcare teams should aim to prone patients at least 8 h daily. Future research should focus on optimizing the tolerance of the technique and comprehensively evaluating benefits in other patient populations.

| S-EPMC9464348 | biostudies-literature

Awake prone positioning in COVID-19: is tummy time ready for prime time?

Project description: Not available

| S-EPMC8378831 | biostudies-literature