TY - JOUR AU - PB, Sryma AU - Mittal, Saurabh AU - Madan, Karan AU - Mohan, Anant AU - Tiwari, Pawan AU - Hadda, Vijay AU - Pandey, Ravindra Mohan AU - Guleria, Randeep PY - 2021/04/22 Y2 - 2024/03/28 TI - Awake prone positioning in non-intubated patients for the management of hypoxemia in COVID-19: A systematic review and meta-analysis JF - Monaldi Archives for Chest Disease JA - Monaldi Arch Chest Dis VL - 91 IS - 2 SE - Physiotherapy - Reviews DO - 10.4081/monaldi.2021.1623 UR - https://www.monaldi-archives.org/macd/article/view/1623 SP - AB - <p>Coronavirus disease-2019 (COVID-19) may lead to hypoxemia, requiring intensive care in many patients. Awake prone positioning (PP) is reported to improve oxygenation and is a relatively safe modality. We performed a systematic review of the literature to evaluate the available evidence and performed meta-analysis of the effect of awake PP in non-intubated patients on improvement in oxygenation and reducing the need for intubation. We searched the PubMed and EMBASE databases to identify studies using awake PP as a therapeutic strategy in the management of COVID-19. Studies were included if they reported respiratory outcomes and included five or more subjects. The quality of individual studies was assessed by the Qualsyst tool. A meta-analysis was performed to estimate the proportion of patients requiring intubation. The degree of improvement in oxygenation parameters (PaO<sub>2</sub>: FiO<sub>2</sub> or PaO<sub>2</sub> or SpO<sub>2</sub>) was also calculated. Sixteen studies (seven prospective trials, three before-after studies, six retrospective series) were selected for review. The pooled proportion of patients who required mechanical ventilation was 0.25 (95% confidence interval (CI) 0.16-0.34). There was a significant improvement in PaO<sub>2</sub>: FiO<sub>2</sub> ratio, PaO<sub>2</sub>, and SpO<sub>2</sub> during awake PP. To conclude, there is limited evidence to support the efficacy of awake PP for the management of hypoxemia in COVID-19. Further RCTs are required to study the impact of awake PP on key parameters like avoidance of mechanical ventilation, length of stay, and mortality.</p> ER -