{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:57:28Z","timestamp":1792519048547,"version":"4.5.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec id=\"ab-ioi250001-4\"><jats:title>Importance<\/jats:title><jats:p>The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-6\"><jats:title>Data Sources<\/jats:title><jats:p>PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-7\"><jats:title>Study Selection<\/jats:title><jats:p>Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-8\"><jats:title>Data Extraction and Synthesis<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-9\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-10\"><jats:title>Results<\/jats:title><jats:p>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, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours\/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi250001-11\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours\/d) was associated with better outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.0011","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T15:01:10Z","timestamp":1741618870000},"page":"572","source":"Crossref","is-referenced-by-count":27,"title":["Awake Prone Positioning in Adults With COVID-19"],"prefix":"10.1001","volume":"185","author":[{"given":"Jian","family":"Luo","sequence":"first","affiliation":[{"name":"Respiratory Medicine Unit and Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, NDM Experimental Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Pavlov","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, H\u00f4pital de Verdun, Montr\u00e9al, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Tavernier","sequence":"additional","affiliation":[{"name":"Methods in Patients-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonatan","family":"Perez","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive\u2013R\u00e9animation, H\u00f4pital de Hautepierre, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen","family":"Kharat","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, H\u00f4pitaux Universitaires de Gen\u00e8ve, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bairbre","family":"McNicholas","sequence":"additional","affiliation":[{"name":"Anaesthesia and Intensive Care, School of Medicine, University of Galway, Galway, 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