俯卧位对清醒非插管的严重 COVID-19 所致呼吸衰竭患者气管插管率、死亡率和氧合参数的影响：系统评价的再评价。
Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews.
机构信息
Student Research Committee, Department of Rheumatology, Tabriz University of Medical Sciences, Tabriz, Iran.
Departments of Anesthesiology and Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
出版信息
Eur J Med Res. 2024 Jan 20;29(1):63. doi: 10.1186/s40001-024-01661-6.
BACKGROUND
Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients.
METHODS
We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05.
RESULTS
Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[- 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[- 4.441, 7.723]; P-value = 0.597).
CONCLUSION
Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number: CRD42022326951. Registered 25 April 2022.
背景
俯卧位（PP）是一种对患者风险极小且成本低廉的方法，可改善 COVID-19 肺炎导致的急性低氧性呼吸衰竭（AHRF）患者的氧合作用，从而降低其对气管插管（TI）和转入重症监护病房（ICU）的需求。我们旨在综述所有先前的系统评价和荟萃分析的结果，以检查 PP 对 COVID-19 患者的氧合、TI 率和死亡率的净影响。
方法
我们从 2019 年 12 月至 2022 年在 PubMed、Scopus、Web of Science、Google Scholar 和 Cochrane 图书馆数据库中进行了无语言限制的检索，以查找关于俯卧位（PP）与仰卧位（SP）在缺氧性呼吸衰竭 COVID-19 意识清醒患者中的比较的系统评价和荟萃分析研究。在研究选择后，从已发表的荟萃分析中提取数据，并通过综合荟萃分析（CMA）软件版本 2.2.064 进行汇总，以实现效应量。对 TI 和死亡率的二分类变量进行分析，并将结果显示为合并优势比（OR）及其 95%置信区间（CI）。对氧合指数（PaO2/FiO2 和 SpO2）等连续变量也进行了分析，并将数据显示为均值差（MD）及其下限和上限 CI。统计学意义水平设为 p≤0.05。
结果
本综述共纳入 12 项系统评价和荟萃分析（共 19651 例患者）和 6 项系统评价（共 2911 例患者），共纳入 22562 例患者。PP 治疗显著降低了 TI 率（OR=0.639，%95 CI（0.492，0.829）；P 值=0.001）和死亡率（OR=0.363，%95 CI（0.240，0.549），P 值<0.001）。PaO2/FiO2（MD=3.591[-40.881，48.062]；P 值=0.874）和 SpO2 百分比（MD=1.641[-4.441，7.723]；P 值=0.597）无差异。
结论
俯卧位可推荐用于 COVID-19 肺炎 ICU 意识清醒的患者，以降低死亡率和插管率。
系统评价注册
PROSPERO 注册号：CRD42022326951。2022 年 4 月 25 日注册。
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