Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A meta-analysis. (October 2022)

• Record Type: Journal Article
• Authors: Ashra, Fauzi; Chen, Ruey; Kang, Xiao Linda; Chiang, Kai-Jo; Pien, Li-Chung; Jen, Hsiu-Ju; Liu, Doresses; Hsiao, Shu-Tai Shen; Chou, Kuei-Ru
• Is Part Of: Intensive and critical care nursing. Volume 72(2022)
• Publication Date: 2022-10
• Subjects: Acute respiratory distress syndrome -- COVID-19 -- Prone position -- Coronavirus 2 -- Respiratory failure; Intensive care nursing -- Periodicals; Critical Illness -- nursing -- Periodicals; Intensive Care -- Periodicals; Nursing Care -- Periodicals; Intensive care nursing; Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.iccn.2022.103257
• Languages: English
• ISSNs: 0964-3397

Abstract

Abstract: Objectives: To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). Research methodology: A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2 /FiO2 ) and secondary outcomes (SpO2 and PaO2 ) Results: A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2 /FiO2 with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. Conclusions: Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.