Introduction
Methods
Data sources and searches
Study selection
Study outcome
Data extraction and risk of bias assessment
Statistical analysis
Results
Clinical course with vs. without awake prone positioning
Author, year | Death in patients treated by aPP n/N (%) | Death in patients not treated by aPP n/N (%) | Orotracheal intubation in aPP patients n/N (%) | Orotracheal intubation in non-aPP patients n/N (%) | RCT | DNR patients (%) |
---|---|---|---|---|---|---|
Alhazzani W., 2022 [17] | 46/205 (22.4) | 46/195 (23.5) | 70/205 (34.1) | 79/195 (40.5) | Yes | Excluded |
Altinay M., 2021 [18] | 9/25 (36.0) | 16/23 (69.8) | 8/25 (32.0) | 19/23 (82.6) | No | n.a |
Ates I., 2021 [19] | 0/97 (0.0) | 4/47 (4.12) | 7/97 (7.2) | 12/47 (25.5) | No | n.a |
Bahloul M., 2021 [20] | 14/21 (66.7) | 12/17 (70.6) | 9/21 (42.8) | 4/17 (23.5) | No | n.a |
Barker J., 2021 [21] | 1/10 (10.0) | 4/10 (40.0) | 6/10 (60.0) | 5/10 (50.0) | No | n.a |
Burton-Papp HC. 2020 [22] | 0/20 (0.0) | 0/20 (0.0) | 7/20 (35.0) | 0/20 (0.0) | No | n.a |
Coppo A., 2020 [23] | 0/47 (0.0) | 0/9 (0.0) | 13/47 (27.6) | 0/9 (0.0) | No | n.a |
Ehrmann S., 2021 [24] | 117/564 (20.7) | 132/557 (23.7) | 185/564 (32.6) | 223/557(40.0) | Yes | Included (8) |
Ferrando C., 2020 [25] | 8/49 (16.3) | 17/122 (13.9) | 22/55 (40.0) | 60/144 (41.7) | No | n.a |
Fralick M., 2022 [26] | 1/126 (0.80) | 1/122 (0.81) | 5/126 (3.9) | 6/122 (4.9) | Yes | Included |
Gad S., 2021 [27] | 3/15 (20.0) | 3/15 (20.0) | 3/15 (20.0) | 3/15 (20.0) | No | n.a |
Graziani M, 2023 [28] | 23/114 (20.1) | 102/422(24.1) | 39/114 (34.2) | 32/422 (7.5) | No | Included (21) |
Hallifax RJ, 2020 [29] | 12/30 (40.0) | 14/18 (77.7) | – | – | No | n.a |
Hashemian SM., 2021 [30] | 9/45 (20.0) | 10/30 (33.3) | 10/45 (22.2) | 12/30 (40.0) | No | n.a |
Hussain HT., 2021 [31] | 1/25 (4.0) | 2/25 (8.0) | – | – | No | n.a |
Imran M., 2021 [32] | 2/50 (4.0) | 3/50 (6.0) | – | – | No | n.a |
Jagan N., 2020 [33] | 0/40 (0.0) | 16/65 (40.0) | 11/40 (27.5) | 26/65 (40.0) | No | n.a |
Jayakumar D., 2021 [34] | 3/30 (10.0) | 2/30 (6.7) | 4/30 (13.3) | 4/30 (13.3) | Yes | n.a |
Johnson SA., 2021 [35] | 2/15 (13.3) | 0/15 (0.00) | 2/15 (13.3) | 1/15 (6.7) | Yes | n.a |
Jouffroy R., 2021 [36] | 4/40 (10.0) | 94/339 (27.7) | 4/40 (10.0) | 200/339(58.9) | No | n.a |
Liu X., 2020 [37] | 0/13 (0.0) | 0/16 (0.0) | n/N (%) | – | No | n.a |
Musso G., 2022 [38] | 10/81 (12.3) | 59/162 (36.4) | 8/81 (9.8) | 44/162 (27.1) | No | Excluded |
Padrao EMH., 2020 [39] | 6/57 (10.5) | 22/109 (20.2) | 33/57 (57.9) | 53/109 (48.6) | No | Excluded |
Perez-Nieto OR. 2021 [40] | 100/505 (1.9) | 120/322 (36.3) | 109/505 (21.5) | 130/322 (40.4) | No | n.a |
Proud’homme E. 2021 [41] | 4/48 (8.3) | 6/120 (5.0) | 7/48 (14.5) | 8/120 (6.6) | No | n.a |
Qian ET., 2022 [42] | 59/239 (24.7) | 47/222 (21.1) | – | – | No | n.a |
Rosen J., 2021 [43] | 6/36 (16.7) | 3/39 (7.7) | 12/36(33.3) | 13/39 (33.3) | Yes | Excluded |
Simioli F., 2021 [44] | 0/18 (0.0) | 3/11 (27.3) | 1/18 (5.5) | 2/11 (18.1) | No | n.a |
Syrma PB., 2021 [45] | 2/30 (6.67) | 4/15 (26.7) | – | – | No | n.a |
Stilma W., 2021 [46] | 91/438 (20.8) | 62/296 (21.0) | – | – | No | n.a |
Thompson A. 2020 [47] | 3/25 (12.0) | 0/40 (0.0) | 13/25 (52.0) | 4/40 (10.0) | No | Included |
Tonelli R., 2021 [48] | 5/38 (13.1) | 17/76 (22.4) | 7/38 (18.4) | 30/76 (39.4) | No | Excluded |
Vianello A., 2021 [49] | 2/50 (0.0) | 7/43 (16.8) | 4/50(8.0) | 12/43 (27.9) | No | Excluded |
Zang X., 2020 [50] | 10/23 (43.5) | 28/37 (75.6) | 8/23 (34.7) | 4/37 (10.8) | No | n.a |
Sensitivity analyses
Sensitivity analyses | Number of studies | Death in patients treated aPP n/N | Death in patients not treated aPP n/N | OR | 95% CI | I2 (%) |
---|---|---|---|---|---|---|
In-hospital death | ||||||
Study design | ||||||
RCTs | 6 | 175/976 | 184/958 | 0.91 | 0.72–1.15 | 0 |
Prospective | 10 | 110/602 | 159/675 | 0.65 | 0.34–1.22 | 65 |
Retrospective | 18 | 268/1591 | 513/2006 | 0.45 | 0.30–0.66 | 57 |
Setting | ||||||
ICU | 15 | 195/1071 | 309/1326 | 0.62 | 0.43–0.89 | 36 |
Non-ICU | 17 | 141/1029 | 295/1434 | 0.62 | 0.36–1.36 | 65 |
ICU and non-ICU | 2 | 217/1069 | 352/876 | 0.59 | 0.30–1.19 | 91 |
Duration of aPP | ||||||
< 6 h | 18 | 225/1367 | 353/1630 | 0.63 | 0.44–0.90 | 33 |
6–12 h | 8 | 141/903 | 308/1085 | 0.42 | 0.28–0.65 | 44 |
> 12h | 3 | 23/112 | 36/184 | 0.85 | 0.25–2.86 | 68 |
Number of patients | ||||||
> 100 | 15 | 474/2641 | 745/3176 | 0.67 | 0.49–0.91 | 69 |
≤ 100 | 19 | 79/528 | 111/463 | 0.50 | 0.30–0.85 | 35 |
Duration of follow-up | ||||||
< 7 days | 7 | 160/809 | 116/612 | 1.08 | 0.68–1.70 | 34 |
7–14 days | 9 | 118/769 | 160/664 | 0.53 | 0.27–1.03 | 44 |
14–28 days | 9 | 156/1064 | 452/1528 | 0.26 | 0.11–0.64 | 86 |
> 28 days | 6 | 88/438 | 190/746 | 0.64 | 0.36–1.14 | 54 |
Period of study recruitment | ||||||
Before Dec-31-2020 | 25 | 390/2123 | 669/2687 | 0.57 | 0.41–0.79 | 59 |
After Dec-31-2020 | 9 | 73/633 | 127/681 | 0.59 | 0.31–1.13 | 52 |
Risk of bias | ||||||
High | 9 | 262/1432 | 390/1748 | 0.82 | 0.57–1.18 | 62 |
Moderate | 19 | 263/1553 | 421/1661 | 0.50 | 0.33–0.75 | 56 |
Low | 6 | 28/184 | 45/230 | 0.48 | 0.22–1.08 | 37 |
DNR | ||||||
Included | 3 | 143/703 | 234/1019 | 0.87 | 0.58–1.20 | 37 |
Excluded | 6 | 75/467 | 154/624 | 0.55 | 0.29–1.06 | 66 |
Not known | 28 | 364/2077 | 525/2337 | 0.58 | 0.43–0.80 | 49 |
Orotracheal intubation | ||||||
Study design | ||||||
RCTs | 6 | 278/976 | 326/958 | 0.76 | 0.62–0.93 | 0 |
Prospective | 8 | 82/339 | 139/460 | 1.00 | 0.42–2.36 | 77 |
Retrospective | 13 | 247/1035 | 521/1601 | 0.78 | 0.35–1.75 | 91 |
Setting | ||||||
ICU | 12 | 161/564 | 450/977 | 0.53 | 0.30–0.93 | 72 |
Non-ICU | 12 | 137/591 | 177/1041 | 1.44 | 0.65–3.22 | 85 |
ICU and non-ICU | 2 | 294/1069 | 353/876 | 0.55 | 0.31–0.98 | 88 |
Duration of aPP | ||||||
< 6h | 16 | 369/1298 | 608/1526 | 0.89 | 0.55–1.44 | 72 |
6–12 h | 5 | 170/835 | 334/1019 | 0.33 | 0.06–1.87 | 97 |
> 12 h | 3 | 43/116 | 92/206 | 0.54 | 0.16–1.78 | 79 |
Number of patients | ||||||
> 100 | 13 | 507/1970 | 903/2683 | 0.68 | 0.41–1.12 | 90 |
≤ 100 | 14 | 100/380 | 83/339 | 1.23 | 0.57–2.67 | 71 |
Duration of follow-up | ||||||
< 7 days | 2 | 16/62 | 3/24 | 1.99 | 0.28–14.05 | 31 |
7–14 days | 7 | 149/706 | 182/598 | 0.76 | 0.38–1.52 | 66 |
14–28 days | 9 | 278/1055 | 622/1513 | 0.46 | 0.26–0.82 | 80 |
> 28 days | 5 | 133/428 | 140/736 | 1.39 | 0.42–4.60 | 92 |
Period of study recruitment | ||||||
Before 31/12 | 20 | 498/1842 | 823/2418 | 0.75 | 0.65–0.87 | 86 |
After 31/12 | 5 | 33/323 | 79/396 | 0.48 | 0.30–0.76 | 41 |
Risk of bias | ||||||
High | 8 | 339/1193 | 397/1546 | 1.29 | 0.59–2.81 | 90 |
Moderate | 16 | 237/1077 | 521/1324 | 0.66 | 0.37–1.18 | 81 |
Low | 3 | 31/80 | 68/165 | 0.95 | 0.52–1.72 | 0 |
DNR | ||||||
Included | 3 | 237/703 | 259/1019 | 3.36 | 0.56–20.0 | 97 |
Excluded | 6 | 307/995 | 441/1142 | 0.61 | 0.40–0.92 | 67 |
Not known | 17 | 221/1054 | 490/1254 | 0.71 | 0.42–1.21 | 73 |