Prone Versus Supine Position in Intubated COVID-19 Patients With ARDS: A Systematic Review and Meta-Analysis

Abstract

BackgroundThis review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with severe ARDS.MethodsA computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adults (≥ 18 years old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position group. Secondary outcomes were PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.ResultsA total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to supine position (MD 60.17, 95% CI 46.86 - 73.47; p < 0.00001). Four studies reported the PaCO2 measurement and showed no significant difference between prone and supine position (MD 2.07, 95% CI -2.79 - 6.92; p <0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and one study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.ConclusionThis meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS.