Awake Prone Positioning in Adults With COVID-19

作者：Jian Luo, Ivan Petrovitch Pavlov, Elsa Tavernier, Yonatan Perez, Aileen Kharat, Bairbre McNicholas, Oriol Roca, David Vines, Miguel Ibarra‐Estrada, Waleed Alhazzani, Kimberley Lewis, Steven Q. Simpson, Garrett Rampon, Ling Liu, Qin Sun, Haibo Qiu, Yi Yang, Giuseppe Lapadula, Edward T. Qian, Cheryl L. Gatto, Todd W. Rice, Ken Kuljit S. Parhar, Jason Weatherald, Allan J. Walkey, Nicholas A. Bosch, Mai-Anh Nay, Thierry Boulain, Guillaume Fossat, Tim R.E. Harris, Louise Thwaites, Nguyen Thanh Phong, Paolo Bonfanti, Sajad Yarahmadi, Seyed Mohammadreza Hashemian, Devachandran Jayakumar, Stephanie Parks Taylor, Stacy A. Johnson, Claude Guérin, John G. Laffey, Stéphan Ehrmann, Jie Li, Awake Prone Positioning Meta-Analysis Group, Sheryl Ann Abdukahil, Dan Adler, Ritwick Agrawal, Guadalupe Aguirre-Ávalos, Ali Ait Hssain, Zainab Al Duhailib, Abdulrahman Al‐Fares, Fahad Al-Hameed, Nijat Aliyev, Mohammed Alshahrani, Olga Amusina, James Anibal, Laura Antolini, Yaseen M. Arabi, Nicholas Arnold, Luu Hoai Bao Tran, Abi Beane, Shashi Bellam, Emilie P. Belley‐Côté, Gordon R. Bernard, Zain A. Bhutta, Ho Bich Hai, Adrien Bigot, Frederic T. Billings, Luca Bisi, Nicolas Bizien, Jonathan Boltax, Sarah Buabbas, Reagan Buie, Henry Bundy, Jessica G. Burke, Cao Thi Cam Van, Chloé Cantero, Amy Hajari Case, Richard Centofanti, Jamal Chalabi, Jefferson Chambers, Wei Chang, Yali Chao, Tao Chen, Tayebeh Cheraghian, Sujith V. Cherian, Jérémy Clément, David A. Clifton, L. Colombain, Paola Columpsi, Deborah J. Cook, Grégory Corvaisier, David Cosgrave, Sarah Culgin, Ashwin D’Silva, Mary Lynn Dear, Jean Dellamonica, Gheorghe Doros, Sylvie Druelle, Erick Duan, Nguyễn Thị Phương Dung, Nguyen Thanh Dung, Elise Dupuis‐Lozeron, Farzad Ebrahimzadeh, Mahtab Eskini, Eddy Fan, Miriam Fezzi, Kirsten M. Fiest, Ernest A. Fischer, Sergio Foresti, Robert E. Freundlich, Matthew Fuller, Yue Gao, Michael A. Garcia, Roxana García-Salcido, Ronald B. Geskus, Kari R. Gillmeyer, Guy Glover, Ignacio Miguel Gomez Macineira, Wu Gong, Nicholas G. Griffiths, Jillann Grooms, Olivier Grosgurin, Jibin Han, Frank E. Harrell, Cassandra Hennessy, Victor Ramon Garcia Hernandez, Raphaël Hindre, William Hiser, Vo Tan Hoang, Du Hong Duc, Devin Horton, Francesca Iannuzzi, Nikhil Jagan, Hamidreza Jamaati, Simon Jamard, Badr Jandali, Jean–Paul Janssens, Dev Jayaraman, Joseph Dahine, Shijing Jia, Jun Jin, Evelyne Kestelyn, Le Thuy Thuy Khanh, Nadir Kharma, Mohamad Khatib, Tran Dang Khoa, Batoul Khoundabi, Marc Kowalkowski, Sunil Kripalani, Frédéric Lador, Jean-Baptiste Lainé, Michael J. Lanspa, François Lauzier, Yang Li, Rachel Lim, Silvia Limonta, Christopher J. Lindsell, Linh Nguyen Thi My, Weili Liu, Yu Liu, Sanaz Lolachi, Vo Trieu Ly, J. Jeffrey Malatack, Majid Malekmohammad, Christophe Marti, Alejandro Martín‐Quirós, Joan Ramón Masclans, Megan Mattingly, Maureen O. Meade, Guglielmo Marco Migliorino, Kristin S. Miller, Sara Mirza, Katherine L. Modzelewski, Idrees Mogri, Fatemeh Mohamadipour, Mohamed Gafar Hussein Mohamedali, Morten Hylander Møller, Marine Morrier, Laveena Munshi, Mai-Anh Nay, Katlynne Nelson, Nguyễn Thanh Ngọc, Nguyen Thanh Nguyen, Daniel J. Niven, Saad Nseir, Elsa Nyamankolly, Sameer A. Pathan, Ankush Pathare, Dan Perri, Christophe Perrin, Dang Phuong Thao, Benjamin Planquette, Laurent Plantier, Jérôme Plojoux, Ester Pollastri, Xavier Pouget-Abadie, Xuehua Pu, Jill M. Pulley, Isma Qureshi, Ebenezer Rabindrarajan, Amera A. Rahmatullah, Pratheema Ramachandran, Nagarajan Ramakrishnan, Tasleem Raza, Bram Rochwerg, Jorge Rosales García, Craig S. Ross, Marianna Rossi, Justin M. Rucci, Alban Rugova, Francesca Sabbatini, Amen Sergew, Aymeric Sève, Navid Shafigh, Sara Skavroneck, Arthur S. Slutsky, William Smith, Paola M. Soccal, Kevin Solverson, Alessandro Soria, Nicola Squillace, Henry T. Stelfox, Payam Tabarsi, Hani Tamim, Le Van Tan, Maged Tanios, Brice Taylor, Lehana Thabane, Stephen H. Thomas, Guy Thwaites, Pham Tieu Kieu, Haytham Tlayjeh, Nguyen Thi Diem Trinh, Matthew W Trump, Nguyen Thanh Truong, Jennifer Tsang, Nguyen Le Nhu Tung, Maria Grazia Valsecchi, Le Dinh Van Khoa, Eduard E. Vasilevskis, Ramesh Venkataraman, Tran Thi Dong Vien, Bharath Kumar Tirupakuzhi Vijayaraghavan, Sicong Wang, Bin Wu, Jianfeng Xie, Jane Yee, Lam Minh Yen, Jiangquan Yu, Arwa Zakaria, Hongsheng Zhao, Ying Zhu · 发表于：JAMA Internal Medicine · 年份：2025 · DOI：10.1001/jamainternmed.2025.0011 · 被引用次数：23 · 研究领域：Respiratory Support and Mechanisms、Pneumothorax, Barotrauma, Emphysema、Cardiovascular and Diving-Related Complications

Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. Data Sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Study Selection: Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Data Extraction and Synthesis: Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. Main Outcomes and Measures: The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. Results: A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age,...