Efficacy of Early Prone Position on Non-Intubated COVID-19 Patients with Respiratory Failure- A Systemic Review and Meta-Analysis

IntroductionCoronaviruses are one of the common viruses that can cause diseases for humans and animals. In December 2019, a new coronavirus (Novel Coronavirus) was detected as the cause of pneumonia and then respiratory failure. One of the modalities that have been used for treatment is prone positioning. The purpose of this meta-analysis was to investigate the efficacy of awake early prone positioning on COVID-19 patients with respiratory failure.Methods We performed a comprehensive search in the literature for studies that evaluated prone positioning in COVID-19. We searched the databases of PubMed/MEDLINE, Embase, World Health Organization COVID-19 Database, LitCOVID, and Web of Science Core Collection databases from January 1, 2020, until November 30, 2020. The search was not limited by language, study design, or country of origin. Two researchers (MA and SG) independently selected the studies;discrepancies were resolved by a third researcher (OS). We considered randomized controlled trials, cohort studies, case-control studies, and case series. We excluded animal studies, case reports, reviews, editorials, and letters to editors. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The random-effects model was used to calculate the odds ratios (OR), and confidence intervals (CI). Our main outcomes were intubation rate and mortality rate for patients who were admitted to the hospital with hypoxic respiratory failure. Results We included 3 studies in our meta-analysis with a total of 290 patients. There was no significant difference between prone positioned awake patients compared to non-prone positioned awake patients regarding intubation rate OR 1.48 ( 95% CI: 0.751-2.927, P-value: 0.257 ) (Figure 1) and mortality rate OR 0.54 ( 95% CI: 0.219-1.326, Pvalue: 0.179) (Figure 2). Conclusion Early awake prone positioning does not have a significant impact on nonintubated COVID-19 patients with respiratory failure according to our meta-analysis. More randomized controlled trials should be done to evaluate the efficacy.