Evidence map›Paper›PMID 40206341›Full record

ArticleEuropean journal of anaesthesiology and intensive care2025

The effect of culture on the benefits of awake prone positioning for adults with COVID-19 acute respiratory distress syndrome: A systematic review and meta-analysis.

Sowmyashree Kota Karanth, Saajid Z Azhar, Maria J Corrales-Martinez, Vijay Krishnamoorthy, Pattrapun T Wongsripuemtet, Julien Cobert, Mona Hashemaghaie, Karthik Raghunathan

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In one paragraph

Article in European journal of anaesthesiology and intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 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

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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

8 authors.

Sowmyashree Kota KaranthFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Saajid Z AzharFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Maria J Corrales-MartinezFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Vijay KrishnamoorthyFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Pattrapun T WongsripuemtetFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Julien CobertFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Mona HashemaghaieFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).
Karthik RaghunathanFrom the Department of Anesthesiology, Duke University, Durham, North Carolina (SKK, MJC-M, VK, PTW, MH, KR), Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Lousiana (SZA) and Department of Anesthesiology, University of California, San Francisco, California, USA (JC).

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
NIA NIH HHS P30 AG044281
6 · The paper itself

Abstract

backgroundRandomised controlled trials (RCTs) conducted early during the pandemic showed that awake prone positioning (APP) significantly reduced the risk of intubation among adults with COVID-19 acute respiratory distress syndrome (ARDS), but more recent studies have questioned this benefit. We hypothesise that the effects of APP may vary with the national Power Distance Index (PDI), a measure of hierarchy in local culture.

objectiveTo conduct a meta-analysis examining the effects of APP in adults with COVID-19 ARDS and examine whether effects differ between nations with a PDI less than 80 versus at least 80 (low versus high deference to authority).

designSystematic review and meta-analysis of RCTs. DATA SOURCES: Cumulated Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Medline and Scopus were searched to November 2024. ELIGIBILITY CRITERIA: All RCTs that compared APP with standard care in adults with COVID-19-related ARDS or Acute Hypoxaemic Respiratory Failure (AHRF) were included.

resultsTwenty-two RCTs were identified with 3615 patients having valid data. APP reduced the risk of intubation [relative risk (RR) 0.80, 95% confidence interval (CI), 0.72 to 0.90]. Effects were greater in nations with a PDI at least 80 (RR 0.67, 95% CI, 0.54 to 0.82), and there was equipoise in nations with a PDI less than 80 (RR 0.89, 95% CI, 0.75 to 1.05). Intubation rates in the high PDI nations decreased from 32.3% (

conclusionAPP reduces the risk of intubation and mortality, but the significance of this benefit varies with the cultural context. Effects are strong in nations with a higher PDI, where intubation rates are lower and adherence to APP higher.

Identifiers

PMID40206341
PMCPMC11977753

What Socratic holds

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LicenceCC BY-SA
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Registered trials

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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.