Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis - 29/04/21
, Jessica Downing a, Reem Alfalasi a, Vera Bzhilyanskaya b, David Milzman a, Mehboob Rehan c, Bradford Schwartz d, Isha Yardi b, Fariba Yazdanpanah e, Quincy K. Tran a, b, f, 1
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Abstract |
Background |
Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease's novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP.
Methods |
We searched PubMed, Embase, and Scopus databases through August 15, 2020 to identify relevant randomized control trials, observational studies, and case series. We performed random-effects meta-analyses for the primary outcome of intubation rate. We used moderator analysis and meta-regressions to assess sources of heterogeneity. We used the standard and modified Newcastle-Ottawa Scales (NOS) to assess studies' quality.
Results |
Our search identified 1043 articles. We included 16 studies from the original search and 2 in-press as of October 2020 in our analysis. All were observational studies. Our analysis included 364 patients; mean age was 56.8 (SD 7.12) years, and 68% were men. The intubation rate was 28% (95% CI 20%–38%, I2 = 63%). The mortality rate among patients who underwent awake PP was 14% (95% CI 7.4%–24.4%). Potential sources of heterogeneity were study design and setting (practice and geographic).
Conclusions |
Our study demonstrated an intubation rate of 28% among hypoxic patients with COVID-19 who underwent awake PP. Awake PP in COVID-19 is feasible and practical, and more rigorous research is needed to confirm this promising intervention.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Awake proning was associated with an intubation rate of 28% among COVID-19 patients |
• | The majority of available evidence is of low to moderate quality |
• | Variability in study designs and locations likely contributed to high heterogeneity |
• | Data from a variety of practice settings suggests awake proning is widely feasible |
• | Additional, more rigorous evidence is needed to confirm efficacy, guide practice |
Keywords : COVID-19, Coronavirus, Prone positioning, Awake Proning, Intubation, Noninvasive ventilation
Plan
Vol 43
P. 88-96 - mai 2021 Retour au numéro
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