TY - JOUR
T1 - Prone vs supine position in intubated COVID-19 patients with ARDS
T2 - a systematic review and meta-analysis
AU - Aditianingsih, Dita
AU - Sugiarto, Adhrie
AU - Manggala, Sidharta Kusuma
AU - Angkasa, Hansen
AU - Natanegara, Ahmad Pasha
N1 - Funding Information:
We would like to thank Fathimah Azzahra for her effort in proof-reading our manuscript.
Publisher Copyright:
© 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Background & Objective: The recent COVID-19 pandemic has tested the healthcare sector to the maximum, but it also has taught us some valuable lessons, especially in the context of intensive care, and particularly in the respiratory support. This review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with ARDS. Methodology: A computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adult (≥ 18 y old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position groups. Secondary outcomes were comparisons of PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies. Results: A total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to the supine position (MD 60.17, 95% CI 46.86−73.47; P < 0.00001). Four studies reported the PaCO2 measurements and showed no significant difference between prone and supine positions (MD 2.07, 95% CI -2.79−6.92; P < 0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and the other study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group. Conclusion: This meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS. It also prolonged ICU stay and mechanical ventilation duration, but had no effect on mortality rate.
AB - Background & Objective: The recent COVID-19 pandemic has tested the healthcare sector to the maximum, but it also has taught us some valuable lessons, especially in the context of intensive care, and particularly in the respiratory support. This review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with ARDS. Methodology: A computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adult (≥ 18 y old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position groups. Secondary outcomes were comparisons of PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies. Results: A total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to the supine position (MD 60.17, 95% CI 46.86−73.47; P < 0.00001). Four studies reported the PaCO2 measurements and showed no significant difference between prone and supine positions (MD 2.07, 95% CI -2.79−6.92; P < 0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and the other study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group. Conclusion: This meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS. It also prolonged ICU stay and mechanical ventilation duration, but had no effect on mortality rate.
KW - ARDS, Intubation
KW - COVID-19
KW - Meta-Analysis
KW - Prone Position
KW - Supine Position
UR - http://www.scopus.com/inward/record.url?scp=85167901977&partnerID=8YFLogxK
U2 - 10.35975/apic.v27i4.2136
DO - 10.35975/apic.v27i4.2136
M3 - Article
AN - SCOPUS:85167901977
SN - 1607-8322
VL - 27
SP - 535
EP - 544
JO - Anaesthesia, Pain and Intensive Care
JF - Anaesthesia, Pain and Intensive Care
IS - 4
ER -