Awake Prone Positioning: Which COVID Patients Benefit?


A meta-analysis showed that the awake prone position reduced the need for intubation in selected patients with severe COVID-19.

According to Rush University’s Ji Lee, PhD, in pooled randomized controlled trials (RCTs), the awake prone position increased the risk of acute hypoxemic respiratory failure (RR 0.84, 95% CI 0.72–0.97) in COVID-19 patients. significantly reduced the need for intubation. in Chicago, and colleagues.

However, varying by patient status at enrollment, benefit was seen only among patients with advanced respiratory support (RR 0.83, 95% CI 0.71–0.97) or in ICU (RR 0.83, 95% CI 0.71–0.97). the authors reported Lancet Respiratory Medicine,

“Since the early stages of the COVID-19 pandemic, the awake state has been demonstrated widely across the world” and recommended NIH COVID-19 Treatment Guidelines and by Other expert panels, the authors noted. However, the awake prone position prevents data intubation. are conflicting,

Previous research has suggested that patients can lie on their stomachs in this position. Improve gas exchange and reduce lung tension,

In this study, while prone position reduced the risk of intubation for patients with more severe COVID-19, it did not significantly reduce mortality (RR 1.00, 95% CI 0.70 to 1.44).

In a meta-analysis a . included data from 2021 meta-trial (consisting of six randomized controlled open-label superiority trials) using high-flow nasal tubes with a total of over 1,000 COVID patients, mostly in the ICU, who found the awake prone position to reduce the need for intubation. It also included data from seven RCTs that did not find a difference in intubation risk among their total of approximately 700 patients on conventional oxygen therapy.

“Provision of advanced respiratory support and an ICU setting are directly correlated,” the researchers wrote. “Taken together, there is a clear lack of effectiveness of the awake prone position in less critically ill patients (receiving non-ICU or conventional oxygen therapy) with lower incidence rates, less intensive monitoring, lower nursing to patient ratios, May be related to low adherence to the awake prone position, and differences in the severity of the patient’s illness,” he said.

“In addition, invasive ventilation was commonly implemented during the early phase of the epidemic,” noted the study authors. As a result, some studies designed at the start of the pandemic were undermined by the time of their completion, and others Couldn’t recruit enough COVID patientsThey said.

The review included studies published in English in January 2020 and early November 2021 without geographic restrictions. In total, 29 studies were included in the review, 10 of which were RCTs (three not yet published), and 19 of which were observational studies. Only observational studies were included in the sensitivity analysis.

RCTs were excluded if they had enrolled children or patients prior to enrollment or if they did not have a control group in the supine position. In the included studies, the time patients spent in the prone position varied greatly, anywhere from 1 to 16 hours or as long as the patient could tolerate, noted Lee and colleagues. The results for patients with low acuity (traditional oxygen therapy or treatment outside the ICU) also had wide confidence intervals, the researchers said.

The study authors acknowledged some limitations of their meta-analysis: the results were primarily driven by three RCTs with large sample sizes, only a few studies that reported duration of the prone position, and those that did Reportedly, the values ​​may not have been accurate because they were “observed and recorded by bedside physicians uncontrollably and with unknown accuracy.”

  • Lei Lei Wu is a staff writer for MedPage Today. He is located in New Jersey. obey

Disclosures

Lee reported on funding from the Fisher & Paykel Healthcare, Aerogen and Rice Foundation, as well as speaker fees from the American Association for Respiratory Care, Aerogen, Hair and Fisher & Paykel Healthcare.

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