Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
J Clin Anesth. 2021 Nov;74:110406. doi: 10.1016/j.jclinane.2021.110406. Epub 2021 Jun 22.
To review the effects of prone position and supine position on oxygenation parameters in patients with Coronavirus Disease 2019 (COVID-19).
Systematic review and meta-analysis of non-randomized trials.
Databases of EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until March 2021.
COVID-19 patients being positioned in the prone position either whilst awake or mechanically ventilated.
Primary outcomes were oxygenation parameters (PaO₂/FiO₂ ratio, PaCO₂, SpO₂). Secondary outcomes included the rate of intubation and mortality rate.
Thirty-five studies (n = 1712 patients) were included in this review. In comparison to the supine group, prone position significantly improved the PaO₂/FiO₂ ratio (study = 13, patients = 1002, Mean difference, MD 52.15, 95% CI 37.08 to 67.22; p < 0.00001) and SpO₂ (study = 11, patients = 998, MD 4.17, 95% CI 2.53 to 5.81; p ≤0.00001). Patients received prone position were associated with lower incidence of mortality (study = 5, patients = 688, Odd ratio, OR 0.44, 95% CI 0.24 to 0.80; p = 0.007). No significant difference was noted in the incidence of intubation rate (study = 5, patients = 626, OR 1.20, 95% CI 0.77 to 1.86; p = 0.42) between the supine and prone groups.
Our meta-analysis demonstrated that prone position improved PaO₂/FiO₂ ratio with better SpO₂ than supine position in COVID-19 patients. Given the limited number of studies with small sample size and substantial heterogeneity of measured outcomes, further studies are warranted to standardize the regime of prone position to improve the certainty of evidence. PROSPERO Registration: CRD42021234050.
回顾俯卧位和仰卧位对 2019 年冠状病毒病（COVID-19）患者氧合参数的影响。
非随机试验的系统评价和荟萃分析。
从 EMBASE、MEDLINE 和 CENTRAL 数据库系统地搜索了从其成立到 2021 年 3 月的文献。
COVID-19 患者清醒或机械通气时处于俯卧位。
主要结局为氧合参数（PaO₂/FiO₂ 比值、PaCO₂、SpO₂）。次要结局包括插管率和死亡率。
本综述纳入了 35 项研究（n=1712 例患者）。与仰卧位组相比，俯卧位显著改善了 PaO₂/FiO₂ 比值（研究=13，患者=1002，平均差异，MD 52.15，95%CI 37.08 至 67.22；p<0.00001）和 SpO₂（研究=11，患者=998，MD 4.17，95%CI 2.53 至 5.81；p≤0.00001）。接受俯卧位的患者死亡率较低（研究=5，患者=688，比值比，OR 0.44，95%CI 0.24 至 0.80；p=0.007）。仰卧位和俯卧位组的插管率（研究=5，患者=626，OR 1.20，95%CI 0.77 至 1.86；p=0.42）无显著差异。
我们的荟萃分析表明，与仰卧位相比，俯卧位可改善 COVID-19 患者的 PaO₂/FiO₂ 比值，使 SpO₂更好。鉴于研究数量有限，样本量小，测量结果存在较大异质性，需要进一步研究以规范俯卧位治疗方案，提高证据确定性。PROSPERO 注册号：CRD42021234050。
