Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A meta-analysis

Fauzi Ashra, Ruey Chen, Xiao Linda Kang, Kai Jo Chiang, Li Chung Pien, Hsiu Ju Jen, Doresses Liu, Shu Tai Shen Hsiao, Kuei Ru Chou

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). Research methodology: A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) Results: A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. Conclusions: Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.

Original languageEnglish
Article number103257
JournalIntensive and Critical Care Nursing
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • Acute respiratory distress syndrome
  • Coronavirus 2
  • COVID-19
  • Prone position
  • Respiratory failure

ASJC Scopus subject areas

  • Critical Care

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