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.
Fauzi Ashra, Ruey Chen, Xiao Linda Kang and 6 others
PMID 35672215WHAT IT FOUND
Prone positioning improved oxygenation in 288 patients with ARDS related to COVID-19.
The benefit was larger in patients with obesity class II and when sessions lasted longer, but the evidence came mostly from small, single-group studies without control groups.
Key findings
01Prone positioning significantly improved the ratio of arterial oxygen to inspired oxygen (PaO2/FiO2), a measure of how well the lungs are getting oxygen into the blood.
02Patients with obesity class II showed the largest improvement in oxygenation from prone positioning compared to other body mass index groups.
03Longer duration of prone positioning per day and total time spent prone per patient were significantly linked to better oxygenation outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis included many small studies, some with as few as 7 participants, and most lacked a control group, meaning we cannot rule out that patients would have improved anyway. There was very high heterogeneity between the studies, indicating that the included studies varied greatly in their designs and patient populations. The quality of evidence was assessed as moderate for most included studies, and the agreement between reviewers who assessed study quality was only fair.
Declared interests
The authors declared no competing financial interests or personal relationships.
The easy way to misread this
Do not assume prone positioning is proven to reduce mortality or prevent intubation. This analysis only shows that oxygen levels improved in the short term, and because most included studies had no control group, we do not know if these patients would have had similar improvements without the intervention.