954: Prone Ventilation in Intubated Covid-19 Patients: Systematic Review and Meta-Analysis

Abstract

INTRODUCTION:Prone ventilation is a well-established strategy in patients with severe ARDS as it has been shown to improve survival and mortality. However, in intubated patients with COVID-19 pneumonia, the data are limited, with no substantial evidence supporting its use. This meta-analysis is the first to examine the mortality benefit of prone ventilation in intubated COVID-19 patients. METHODS:A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in Medline, Embase, and Web of Science databases was conducted in January 2022 for published studies assessing the mortality benefit of prone ventilation in intubated COVID-19 patients.RESULTS: Four hundred sixty-seven studies were identified. Of those, five studies met the inclusion criteria studies were included. The total number of patients included in the studies was 4247 patients. In four studies, ARDS prevalence was reported. The prone group had a higher prevalence of severe ARDS rates than the supine group. No significant difference was found between prone or supine groups in ICU mortality (OR: 1.39; 95%CI: 0.80-2.43; p=0.24). Regarding overall mortality, No difference was detected between the prone or the supine groups (OR: 1.04; 95%CI: 0.57-1.87; p = 0.9), with significant heterogeneity (I2= 93; p < 0.001). The length of hospital stay (LOS) was reported in two studies. Our analysis showed that LOS did not differ between the prone and supine groups (SMD: 0.77; 95%CI: -0.33-1.86; p=0.17). CONCLUSIONS:Prone ventilation in intubated COVID-19 patients does not offer a mortality benefit. Randomized controlled trials are warranted to confirm this finding and clarify whether specific subpopulations may benefit from prone ventilation.

Prone Vs. Supine Position Ventilation in Intubated COVID-19 Patients: A Systematic Review and Meta-Analysis

“…This article was previously presented as a meeting abstract at the 2023 Society of Critical Care Congress on January 23, 2023 [ 16 ].…”

Prone Position and the Risk of Venous Thrombosis in COVID-19 Patients with Respiratory Failure

“…1 A recent meta-analysis of seven retrospective cohort studies including 5216 COVID-19 patients concluded that intensive care unit (ICU) mortality was higher in the prone position, while no significant differences were found in terms of cumulative or hospital mortality, length of stay in the ICU, and duration of mechanical ventilation between prone and supine positions. 2 In addition, there is evidence that the prone position may have several adverse side effects, some of which are clearly acknowledged (e.g., pressure ulcers, nerve injury, bleeding, displacement of medical devices, etc. ), 3 while others are often overlooked.…”