Evidence map›Paper›PMID 36769574›Full record

ReviewJournal of clinical medicine2023

Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials.

Huzaifa Ahmad Cheema, Amna Siddiqui, Sidhant Ochani, Alishba Adnan, Mahnoor Sukaina, Ramsha Haider, Abia Shahid, Mohammad Ebad Ur Rehman, Rehmat Ullah Awan, Harpreet Singh and 4 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 3 pooled it
–field-weighted citation impact
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

6 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Huzaifa Ahmad CheemaIntensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan.ORCID 0000-0001-6783-7137
Amna SiddiquiDepartment of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan.ORCID 0000-0001-9372-0362
Sidhant OchaniDepartment of Medicine, Khairpur Medical College, Khairpur 66020, Pakistan.ORCID 0000-0003-2079-148X
Alishba AdnanDepartment of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan.
Mahnoor SukainaDepartment of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan.
Ramsha HaiderDepartment of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan.ORCID 0000-0001-7662-9153
Abia ShahidIntensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan.
Mohammad Ebad Ur RehmanDepartment of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan.
Rehmat Ullah AwanDepartment of Medicine, Ochsner Rush Medical Center, Meridian, MS 39301, USA.
Harpreet SinghDivision of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Natalie DuricCritical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK.
Brigitta FazziniAdult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK.ORCID 0000-0003-3569-1203
Antoni TorresDepartment of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.ORCID 0000-0002-8643-2167
Tamas SzakmanyCritical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK.ORCID 0000-0003-3632-8844

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAwake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it.

methodsWe searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events.

resultsWe included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74-0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77-1.11; moderate certainty) and did not increase the risk of adverse events.

conclusionsIn patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.

Indexed as

acute respiratory failureawake prone positioningCOVID-19intubationmortality

Identifiers

PMID36769574
PMCPMC9917863

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.