Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis

Behesht Aeen, Fatemeh; Pakzad, Reza; Goudarzi Rad, Mohammad; Abdi, Fatemeh; Zaheri, Farzaneh; Mirzadeh, Narges

Prone position (PP) is known to improve oxygenation and reduce mortality in COVID-19 patients. This systematic review and meta-analysis aimed to determine the effects of PP on respiratory parameters and outcomes. PubMed, EMBASE, ProQuest, SCOPUS, Web of Sciences, Cochrane library, and Google Scholar were searched up to 1st January 2021. Twenty-eight studies were included. The Cochran's Q-test and I(2) statistic were assessed heterogeneity, the random-effects model was estimated the pooled mean difference (PMD), and a meta-regression method has utilized the factors affecting heterogeneity between studies. PMD with 95% confidence interval (CI) of PaO(2)/FIO(2) Ratio in before–after design, quasi-experimental design and in overall was 55.74, 56.38, and 56.20 mmHg. These values for Spo(2) (Sao(2)) were 3.38, 17.03, and 7.58. PP in COVID-19 patients lead to significantly decrease of the Paco(2) (PMD: − 8.69; 95% CI − 14.69 to − 2.69 mmHg) but significantly increase the PaO(2) (PMD: 37.74; 95% CI 7.16–68.33 mmHg). PP has no significant effect on the respiratory rate. Based on meta-regression, the study design has a significant effect on the heterogeneity of Spo(2) (Sao(2)) (Coefficient: 12.80; p < 0.001). No significant associations were observed for other respiratory parameters with sample size and study design. The pooled estimate for death rate and intubation rates were 19.03 (8.19–32.61) and 30.68 (21.39–40.75). The prone positioning was associated with improved oxygenation parameters and reduced mortality and intubation rate in COVID-19 related respiratory failure.