School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Institut Kesehatan Prima Nusantara Bukittinggi, Bukittinggi, Indonesia.
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Intensive Crit Care Nurs. 2022 Oct;72:103257. doi: 10.1016/j.iccn.2022.103257. Epub 2022 Apr 11.
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).
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 (PaO/FiO) and secondary outcomes (SpO and PaO) RESULTS: A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO/FiO with standardised mean difference of 1.10 (95%CI 0.60-1.59), SpO with standardised mean difference of 3.39 (95% CI 1.30-5.48), and PaO 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.
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.
研究俯卧位对伴有急性呼吸窘迫综合征的 COVID-19 患者的疗效，并探讨在传统俯卧位（有创机械通气）和清醒自主俯卧位（无创通气）患者中，不同调节因素对俯卧位的影响。
我们对 CINAHL、考科兰（Cochrane）图书馆、Embase、Medline-OVID、NCBI SARS-CoV-2 资源、ProQuest、Scopus 和 Web of Science 进行了全面检索，检索语种不限。所有前瞻性和实验设计的研究均纳入评估 COVID-19 相关急性呼吸窘迫综合征患者俯卧位效果的研究。对俯卧位后主要结局（PaO/FiO）和次要结局（SpO 和 PaO）进行标准化均数差的汇总分析。
共有 15 篇文章符合纳入标准，并最终纳入分析。俯卧位可显著改善 PaO/FiO（标准化均数差为 1.10，95%置信区间为 0.60-1.59）、SpO（标准化均数差为 3.39，95%置信区间为 1.30-5.48）和 PaO（标准化均数差为 0.77，95%置信区间为 0.19-1.35）。BMI 较高和每天持续时间较长的患者俯卧位的标准化均数差效应较大。
本研究结果表明，俯卧位可显著提高伴有急性呼吸窘迫综合征的 COVID-19 患者的氧饱和度，无论是在传统俯卧位还是清醒自主俯卧位患者中。对于 BMI 较高和持续时间较长的患者，应推荐使用俯卧位以获得最大疗效。
