| Article 1 | Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis (Behesht Aeen et al., 2021) |
| Quantitative/ Qualitative? Why? | Mixed method because it employs the Mixed Methods Appraisal Tool |
| Purpose Statement | “The study aimed to determine the effects of prone positioning on respiratory parameters and outcomes.” |
| Research Question | Not given |
| Outcome | “Primary Outcome: the respiratory parameters and respiratory status. Secondary Outcome: death rate and intubation rates.” |
| Setting | UK, China, Spain |
| Sample | “28 studies were qualitatively analyzed, and 26 studies with a total sample size of 1272 participants were quantitatively analyzed.” |
| Method | Systematic review and meta-analysis |
| Key Finding | “The prone positioning was associated with improved oxygenation parameters and reduced mortality and intubation rate in COVID-19 related respiratory failure.” |
| Recommendations for Researchers | Perform gender-specific estimation Perform geographical regions or country-specific estimation |
| Article 2 | Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single-centre cohort study of 20 consecutive patients. (Clarke et al., 2021) |
| Quantitative/ Qualitative? Why? | Quantitative because it uses statistical analysis |
| Purpose Statement | “It aimed to characterize the effects of prone positioning on respiratory mechanics and oxygenation in invasively ventilated patients with SARS-CoV-2 ARDS.” |
| Research Question | Not given |
| Outcome | “The main outcome was the effect of prone positioning on gas exchange and respiratory mechanics.” |
| Setting | Intensive Care Unit (ICU) of a tertiary referral centre |
| Sample | 20 consecutive, invasively ventilated patients with laboratory-confirmed SARS-CoV-2 |
| Method | prospective cohort study |
| Key Finding | “Prone positioning was effective in improving oxygenation in SARS-CoV-2 ARDS.” |
| Recommendations for Researchers | Not given |
| Article 3 | Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study (Perez-Nieto et al., 2021) |
| Quantitative/ Qualitative? Why? | Quantitative because it uses statistical analysis |
| Purpose Statement | “The study aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalization.” |
| Research Question | Not given |
| Outcome | “Primary Outcome: successful orotracheal intubation for invasive mechanical ventilation Secondary Outcome: death during in-hospital follow-up.” |
| Setting | 27 hospitals in Mexico and Ecuador |
| Sample | 827 non-intubated patients with COVID-19 |
| Method | observational study |
| Key Finding | AP in hospitalized non-intubated patients with COVID-19 is associated with a lower risk of intubation and mortality. |
| Recommendations for Researchers | “As studies of awake proning are challenging and randomized, researchers are recommended to conduct controlled trials to fully elucidate its usefulness.” |
| Article 4 | Prone Positioning of Non-intubated Patients with COVID-19 (Damarla et al., 2020) |
| Quantitative/ Qualitative? Why? | Quantitative because it uses statistical analysis |
| Purpose Statement | “The study aimed to determine the benefits that patients with COVID-19 and respiratory distress, not yet intubated but at high risk for intubation, might achieve from prone positioning.” |
| Research Question | Not given |
| Outcome | “Primary outcome: change in oxygen saturation and respiratory rate before proning and approximately 1 hour after initial proning compared with pre-proning. Secondary outcome: incidence of intubation within 2 weeks of the first prone-positioning trial.” |
| Setting | Academic medical center |
| Sample | 10 patients |
| Method | Retrospective review |
| Key Finding | All patients experienced significant improvement in respiratory status during the initial prone-positioning period. |
| Recommendations for Researchers | Future research avenues include: “How long does the effect of proning last? Does the beneficial effect of proning continue after supination? Does proning prevent the need for intubation or merely delay it? Could prone positioning accelerate recovery?” |
| Article 5 | Effect of awake prone positioning in COVID-19 patients- A systematic review (Anand et al., 2021) |
| Quantitative/ Qualitative? Why? | Mixed methods because it employs systematic review of the literature and statistical analysis |
| Purpose Statement | “We aim to conduct a systematic review of the available literature to highlight the effect of awake proning on the need for intubation, improvement in oxygenation, and mortality rates in COVID-19 patients with ARDS.” |
| Research Question | Not given |
| Outcome | “The proportion of patients requiring intubation, improvement in oxygenation, and mortality rates.” |
| Setting | Not given |
| Sample | 2 medical databases (PubMed, Google Scholar) 13 studies with 210 patients |
| Method | Systematic Review of Literature |
| Key Finding | “Awake-prone positioning demonstrated an improvement in oxygenation of the patients suffering from COVID-19 related respiratory disease.” |
| Recommendations for Researchers | “Early and frequent proning in patients suffering from COVID-19 associated ARDS; however, randomized controlled trials are needed before any definite conclusions are drawn.” |
| Article 6 | Prone Position to Improve Oxygenation in COVID-19 Patients Outside Critical Care (PRONE-COVID) (Fuld, 2020) |
| Quantitative/ Qualitative? Why? | Mixed-Method |
| Purpose Statement | “The study aims to improve understanding of physiological effects of prone positioning in non-ventilated patients with COVID-19 and a control group of patients with non-COVID-19 related pneumonia. The study also aims to incorporate a small subset of patients, with an approximately even spread of COVID-19 and non-COVID cases, which allows for an additional exploratory, descriptive report on prone positioning over 24 hours.” |
| Research Question | Not given |
| Outcome | Effects of prone versus supine or lateral position on respiratory rate, heart rate, blood pressure |
| Setting | Cambridge University Hospitals NHS Foundation Trust |
| Sample | 56 participants |
| Method | Interventional Case Study |
| Key Finding | “Prone positioning improves oxygenation in non-ventilated patients with pneumonia (COVID-19 related or not) requiring supplemental oxygen managed outside of the critical care setting.” |
| Recommendations for Researchers | “The Intensive Care Society, in non-ventilated patients with COVID-19, has an urgent need to better understand the physiological effects of prone positioning in such cases.” |
References
Anand, S., Baishya, M., Singh, A., & Khanna, P. (2021). Effect of awake prone positioning in COVID-19 patients- A systematic review. Trends in Anaesthesia and Critical Care, 36, 17–22. https://doi.org/10.1016/j.tacc.2020.09.008
Behesht Aeen, F., Pakzad, R., Goudarzi Rad, M., Abdi, F., Zaheri, F., & Mirzadeh, N. (2021). Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: Systematic review and meta-analysis. Scientific Reports, 11(1), 14407. https://doi.org/10.1038/s41598-021-93739-y
Clarke, J., Geoghegan, P., McEvoy, N., Boylan, M., Ní Choileáin, O., Mulligan, M., Hogan, G., Keogh, A., McElvaney, O. J., McElvaney, O. F., Bourke, J., McNicholas, B., Laffey, J. G., McElvaney, N. G., & Curley, G. F. (2021). Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single-center cohort study of 20 consecutive patients. BMC Research Notes, 14(1), 20. https://doi.org/10.1186/s13104-020-05426-2
Damarla, M., Zaeh, S., Niedermeyer, S., Merck, S., Niranjan-Azadi, A., Broderick, B., & Punjabi, N. (2020). Prone Positioning of Nonintubated Patients with COVID-19. American Journal of Respiratory and Critical Care Medicine, 202(4), 604–606. https://doi.org/10.1164/rccm.202004-1331LE
Fuld, D. J. (2020). Prone Position to Improve Oxygenation in COVID-19 Patients Outside Critical Care (PRONE-COVID Study) (Clinical Trial Registration No. NCT04589936). clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT04589936
Perez-Nieto, O. R., Escarraman-Martinez, D., Guerrero-Gutierrez, M. A., Zamarron-Lopez, E. I., Mancilla-Galindo, J., Kammar-García, A., Martinez-Camacho, M. A., Deloya-Tomás, E., Sanchez-Diaz, J. S., Macías-García, L. A., Soriano-Orozco, R., Cruz-Sánchez, G., Salmeron-Gonzalez, J. D., Toledo-Rivera, M. A., Mata-Maqueda, I., Morgado-Villaseñor, L. A., Martinez-Mazariegos, J. J., Ramirez, R. F., Medina-Estrada, J. L., & Ñamendys-Silva, S. A. (2021). Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study. European Respiratory Journal. https://doi.org/10.1183/13993003.00265-2021
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