García Agustin, Galeiras Rita, Pertega-Díaz Sonia
A Coruna University Hospital, A Coruña, Spain.
University of A Coruna, A Coruña, Spain.
J Crit Care Med (Targu Mures). 2023 May 8;9(2):73-86. doi: 10.2478/jccm-2023-0014. eCollection 2023 Apr.
To date, recommendations for the implementation of awake prone positioning in patients with hypoxia secondary to SARSCoV2 infection have been extrapolated from prior studies on respiratory distress. Thus, we carried out a systematic review and metaanalysis to evaluate the benefits of pronation on the oxygenation, need for endotracheal intubation (ETI), and mortality of this group of patients. We carried out a systematic search in the PubMed and Embase databases between June 2020 and November 2021. A randomeffects metaanalysis was performed to evaluate the impact of pronation on the ETI and mortality rates. A total of 213 articles were identified, 15 of which were finally included in this review. A significant decrease in the mortality rate was observed in the group of pronated patients (relative risk [RR] = 0.69; 95% confidence interval [CI]: 0.480.99; p = 0.044), but no significant effect was observed on the need for ETI (RR = 0.79; 95% CI: 0.631.00; p = 0.051). However, a subgroup analysis of randomized clinical trials (RCTs) did reveal a significant decrease in the need for this intervention (RR = 0.83; 95% CI: 0.710.97). Prone positioning was found to significantly reduce mortality, also diminishing the need for ETI, although this effect was statistically significant only in the subgroup analysis of RCTs. Patients' response to awake prone positioning could be greater when this procedure is implemented early and in combination with noninvasive mechanical ventilation (NIMV) or highflow nasal cannula (HFNC) therapy.
迄今为止，针对新型冠状病毒2感染继发缺氧患者实施清醒俯卧位通气的建议是从先前关于呼吸窘迫的研究中推断出来的。因此，我们进行了一项系统评价和荟萃分析，以评估俯卧位通气对该组患者氧合、气管插管需求及死亡率的益处。我们于2020年6月至2021年11月在PubMed和Embase数据库中进行了系统检索。采用随机效应荟萃分析来评估俯卧位通气对气管插管率和死亡率的影响。共识别出213篇文章，最终15篇纳入本评价。观察到俯卧位通气组患者死亡率显著降低（相对危险度[RR]=0.69；95%置信区间[CI]：0.48-0.99；p=0.044），但对气管插管需求无显著影响（RR=0.79；95%CI：0.63-1.00；p=0.051）。然而，随机临床试验（RCT）的亚组分析确实显示该干预需求显著降低（RR=0.83；95%CI：0.71-0.97）。发现俯卧位通气可显著降低死亡率，也减少气管插管需求，尽管仅在RCT的亚组分析中该效应具有统计学意义。当早期实施清醒俯卧位通气并联合无创机械通气（NIMV）或高流量鼻导管（HFNC）治疗时，患者对此的反应可能更大。
