Evidence map›Paper›PMID 36740866›Full record

SynthesisBMJ (Clinical research ed.)2022

Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials.

Jason Weatherald, Ken Kuljit S Parhar, Zainab Al Duhailib, Derek K Chu, Anders Granholm, Kevin Solverson, Kimberley Lewis, Morten Hylander Møller, Mohammed Alshahrani, Emilie Belley-Cote and 10 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 3 pooled it
9.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 62 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Prone positioning in ARDS.Intensive care medicine · 2026
    Review
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Use of prone position in spontaneous breathing in patients with COVID-19.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2025
    Article
  15. Article
  16. Article
  17. Prone positioning of nonintubated patients with COVID-19 in Australian intensive care units.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2024
    Article
  18. Article
  19. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 11 institutions in 4 countries.

Jason WeatheraldDepartment of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada.
Ken Kuljit S ParharLibin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada ken.parhar@albertahealthservices.ca.ORCID 0000-0002-1113-0287
Zainab Al DuhailibCritical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Derek K ChuDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Anders GranholmDepartment of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Kevin SolversonDepartment of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada.
Kimberley LewisDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Morten Hylander MøllerDepartment of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Mohammed AlshahraniDepartment of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Emilie Belley-CoteDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Nicole LoroffKnowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada.
Edward T QianDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Cheryl L GattoVanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Todd W RiceDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Dan NivenDepartment of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada.
Henry T StelfoxDepartment of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada.
Kirsten FiestDepartment of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada.
Deborah CookDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Yaseen M ArabiCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Waleed AlhazzaniDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Alberta Health Services · CAVanderbilt University Medical Center · USCopenhagen University Hospital · DKImpact · CAImam Abdulrahman Bin Faisal University · SAKing Faisal Specialist Hospital & Research Centre · SAKing Saud bin Abdulaziz University for Health Sciences · SAKing Saud University · SAMcMaster University · CAPopulation Health Research Institute · CAUniversity of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the efficacy and safety of awake prone positioning versus usual care in non-intubated adults with hypoxemic respiratory failure due to covid-19.

designSystematic review with frequentist and bayesian meta-analyses. STUDY ELIGIBILITY: Randomized trials comparing awake prone positioning versus usual care in adults with covid-19 related hypoxemic respiratory failure. Information sources were Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to 4 March 2022. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were performed for the primary and secondary outcomes. Bayesian meta-analyses were performed for endotracheal intubation and mortality outcomes. GRADE certainty of evidence was assessed for outcomes.

main outcome measuresThe primary outcome was endotracheal intubation. Secondary outcomes were mortality, ventilator-free days, intensive care unit (ICU) and hospital length of stay, escalation of oxygen modality, change in oxygenation and respiratory rate, and adverse events.

results17 trials (2931 patients) met the eligibility criteria. 12 trials were at low risk of bias, three had some concerns, and two were at high risk. Awake prone positioning reduced the risk of endotracheal intubation compared with usual care (crude average 24.2%

conclusionsAwake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults with hypoxemic respiratory failure due to covid-19 but probably has little to no effect on mortality or other outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022314856.

Indexed as

COVID-19Respiratory InsufficiencyAdultBayes TheoremHumansOxygenProne PositionRandomized Controlled Trials as TopicWakefulnessOxygen

Identifiers

PMID36740866
PMCPMC9727649
OpenAlexW4313378613

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.