Effect of prone versus supine position in COVID-19 patients: A systematic review and meta-analysis

Chua, Ee Xin and Zahir, Syed Mohd Ikhmal Syed Mohd and Ng, Ka Ting and Teoh, Wan Yi and Hasan, Mohd Shahnaz and Ruslan, Shairil Rahayu Binti and Abosamak, F. Mohammed (2021) Effect of prone versus supine position in COVID-19 patients: A systematic review and meta-analysis. Journal of Clinical Anesthesia, 74. ISSN 0952-8180, DOI https://doi.org/10.1016/j.jclinane.2021.110406.

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Study objective: To review the effects of prone position and supine position on oxygenation parameters in patients with Coronavirus Disease 2019 (COVID-19). Design: Systematic review and meta-analysis of non-randomized trials. Patients: Databases of EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until March 2021. Interventions: COVID-19 patients being positioned in the prone position either whilst awake or mechanically ventilated. Measurements: Primary outcomes were oxygenation parameters (PaO2/FiO2 ratio, PaCO2, SpO2). Secondary outcomes included the rate of intubation and mortality rate. Results: Thirty-five studies (n = 1712 patients) were included in this review. In comparison to the supine group, prone position significantly improved the PaO2/FiO2 ratio (study = 13, patients = 1002, Mean difference, MD 52.15, 95% CI 37.08 to 67.22; p < 0.00001) and SpO2 (study = 11, patients = 998, MD 4.17, 95% CI 2.53 to 5.81; p <= 0.00001). Patients received prone position were associated with lower incidence of mortality (study = 5, patients = 688, Odd ratio, OR 0.44, 95% CI 0.24 to 0.80; p = 0.007). No significant difference was noted in the incidence of intubation rate (study = 5, patients = 626, OR 1.20, 95% CI 0.77 to 1.86; p = 0.42) between the supine and prone groups. Conclusion: Our meta-analysis demonstrated that prone position improved PaO2/FiO2 ratio with better SpO2 than supine position in COVID-19 patients. Given the limited number of studies with small sample size and substantial heterogeneity of measured outcomes, further studies are warranted to standardize the regime of prone position to improve the certainty of evidence. PROSPERO Registration: CRD42021234050

Item Type: Article
Uncontrolled Keywords: Prone; Supine; Coronavirus Disease 2019; Oxygenation; Meta-analysis
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 06 Apr 2022 07:38
Last Modified: 06 Apr 2022 07:38
URI: http://eprints.um.edu.my/id/eprint/28571

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