Ivan Pavlov1, Hangyong He2, Bairbre McNicholas3, Yonatan Perez4, Elsa Tavernier5, Matthew W Trump6, Julie A Jackson7, Wei Zhang8, Daniel S Rubin9, Thomas Spiegel10, Anthony Hung11, Miguel Ángel Ibarra Estrada12, Oriol Roca13, David L Vines14, David Cosgrave3, Sara Mirza15, John G Laffey3, Todd W Rice16, Stephan Ehrmann17, Jie Li18. 1. Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada. 2. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. 3. Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway and Department of Anaesthesia, University Hospital Galway, Saolta Hospital Group, Galway, Ireland. 4. Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSEP research network, CHRU Tours, Tours, France and INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France. 5. INSERM 1246-SPHERE, Universities of Tours and Nantes, Tours, France; Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France. 6. Department Pulmonary and Critical Care Medicine, The Iowa Clinic, West Des Moines, Iowa. 7. Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa. 8. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, Second Military Medical University, Shanghai, China. 9. Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois. 10. Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. 11. Pritzker School of Medicine, University of Chicago, Chicago, Illinois. 12. Intensive Care Unit, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara. Guadalajara, Jalisco, Mexico. 13. Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. 14. Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois. 15. Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois. 16. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. 17. Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSEP research network, CHRU Tours, Tours, France and INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France. Jie_Li@rush.edu. 18. Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois. Jie_Li@rush.edu.
Abstract
BACKGROUND: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubation of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP. METHODS: We performed a systematic review of proportional outcomes from observational studies to compare intubation rate in patients treated with APP or with standard care. RESULTS: A total of 46 published and 4 unpublished observational studies that included 2,994 subjects were included, of which 921 were managed with APP and 870 were managed with usual care. APP was associated with significant improvement of oxygenation parameters in 381 cases of 19 studies that reported this outcome. Among the 41 studies assessing intubation rates (870 subjects treated with APP and 852 subjects treated with usual care), the intubation rate was 27% (95% CI 19-37%) as compared to 30% (95% CI 20-42%) (P = .71), even when duration of application, use of adjunctive respiratory assist device (high-flow nasal cannula or noninvasive ventilation), and severity of oxygenation deficit were taken into account. There appeared to be a trend toward improved mortality when APP was compared with usual care (11% vs 22%), which was not statistically significant. CONCLUSIONS: APP was associated with improvement of oxygenation but did not reduce the intubation rate in subjects with acute respiratory failure due to COVID-19. This finding is limited by the high heterogeneity and the observational nature of included studies. Randomized controlled clinical studies are needed to definitively assess whether APP could improve key outcome such as intubation rate and mortality in these patients.
BACKGROUND: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubation of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP. METHODS: We performed a systematic review of proportional outcomes from observational studies to compare intubation rate in patients treated with APP or with standard care. RESULTS: A total of 46 published and 4 unpublished observational studies that included 2,994 subjects were included, of which 921 were managed with APP and 870 were managed with usual care. APP was associated with significant improvement of oxygenation parameters in 381 cases of 19 studies that reported this outcome. Among the 41 studies assessing intubation rates (870 subjects treated with APP and 852 subjects treated with usual care), the intubation rate was 27% (95% CI 19-37%) as compared to 30% (95% CI 20-42%) (P = .71), even when duration of application, use of adjunctive respiratory assist device (high-flow nasal cannula or noninvasive ventilation), and severity of oxygenation deficit were taken into account. There appeared to be a trend toward improved mortality when APP was compared with usual care (11% vs 22%), which was not statistically significant. CONCLUSIONS: APP was associated with improvement of oxygenation but did not reduce the intubation rate in subjects with acute respiratory failure due to COVID-19. This finding is limited by the high heterogeneity and the observational nature of included studies. Randomized controlled clinical studies are needed to definitively assess whether APP could improve key outcome such as intubation rate and mortality in these patients.
Authors: Miguel Ibarra-Estrada; María J Gamero-Rodríguez; Marina García-de-Acilu; Oriol Roca; Laura Sandoval-Plascencia; Guadalupe Aguirre-Avalos; Roxana García-Salcido; Sara A Aguirre-Díaz; David L Vines; Sara Mirza; Ramandeep Kaur; Tyler Weiss; Claude Guerin; Jie Li Journal: Crit Care Date: 2022-06-27 Impact factor: 19.334
Authors: Stephan Ehrmann; Jie Li; Miguel Ibarra-Estrada; Yonatan Perez; Ivan Pavlov; Bairbre McNicholas; Oriol Roca; Sara Mirza; David Vines; Roxana Garcia-Salcido; Guadalupe Aguirre-Avalos; Matthew W Trump; Mai-Anh Nay; Jean Dellamonica; Saad Nseir; Idrees Mogri; David Cosgrave; Dev Jayaraman; Joan R Masclans; John G Laffey; Elsa Tavernier Journal: Lancet Respir Med Date: 2021-08-20 Impact factor: 30.700
Authors: Ramandeep Kaur; David L Vines; Sara Mirza; Ahmad Elshafei; Julie A Jackson; Lauren J Harnois; Tyler Weiss; J Brady Scott; Matthew W Trump; Idrees Mogri; Flor Cerda; Amnah A Alolaiwat; Amanda R Miller; Andrew M Klein; Trevor W Oetting; Lindsey Morris; Scott Heckart; Lindsay Capouch; Hangyong He; Jie Li Journal: Crit Care Date: 2021-09-17 Impact factor: 9.097