Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
Sci Rep. 2021 Jul 13;11(1):14407. doi: 10.1038/s41598-021-93739-y.
Prone position (PP) is known to improve oxygenation and reduce mortality in COVID-19 patients. This systematic review and meta-analysis aimed to determine the effects of PP on respiratory parameters and outcomes. PubMed, EMBASE, ProQuest, SCOPUS, Web of Sciences, Cochrane library, and Google Scholar were searched up to 1st January 2021. Twenty-eight studies were included. The Cochran's Q-test and I statistic were assessed heterogeneity, the random-effects model was estimated the pooled mean difference (PMD), and a meta-regression method has utilized the factors affecting heterogeneity between studies. PMD with 95% confidence interval (CI) of PaO/FIO Ratio in before-after design, quasi-experimental design and in overall was 55.74, 56.38, and 56.20 mmHg. These values for Spo (Sao) were 3.38, 17.03, and 7.58. PP in COVID-19 patients lead to significantly decrease of the Paco (PMD: - 8.69; 95% CI - 14.69 to - 2.69 mmHg) but significantly increase the PaO (PMD: 37.74; 95% CI 7.16-68.33 mmHg). PP has no significant effect on the respiratory rate. Based on meta-regression, the study design has a significant effect on the heterogeneity of Spo (Sao) (Coefficient: 12.80; p < 0.001). No significant associations were observed for other respiratory parameters with sample size and study design. The pooled estimate for death rate and intubation rates were 19.03 (8.19-32.61) and 30.68 (21.39-40.75). The prone positioning was associated with improved oxygenation parameters and reduced mortality and intubation rate in COVID-19 related respiratory failure.
俯卧位（PP）已知可改善 COVID-19 患者的氧合并降低死亡率。本系统评价和荟萃分析旨在确定 PP 对呼吸参数和结局的影响。截至 2021 年 1 月 1 日，检索了 PubMed、EMBASE、ProQuest、SCOPUS、Web of Sciences、Cochrane 图书馆和 Google Scholar。共纳入 28 项研究。采用 Cochran's Q 检验和 I 统计量评估异质性，采用随机效应模型估计合并均数差（PMD），并采用元回归方法分析影响研究间异质性的因素。在前后设计、准实验设计和总体设计中，PaO/FIO 比值的 PMD 分别为 55.74、56.38 和 56.20mmHg。SpO（SaO）的这些值分别为 3.38、17.03 和 7.58。COVID-19 患者的 PP 可显著降低 Paco（PMD：-8.69；95%CI-14.69 至-2.69mmHg），但可显著升高 PaO（PMD：37.74；95%CI7.16-68.33mmHg）。PP 对呼吸频率无显著影响。基于元回归，研究设计对 Spo（SaO）的异质性有显著影响（系数：12.80；p<0.001）。未观察到其他呼吸参数与样本量和研究设计之间存在显著关联。死亡率和插管率的合并估计值分别为 19.03（8.19-32.61）和 30.68（21.39-40.75）。俯卧位与 COVID-19 相关呼吸衰竭患者的氧合参数改善、死亡率和插管率降低有关。
