{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:22:03Z","timestamp":1784604123504,"version":"3.55.0"},"reference-count":59,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background and aims:<\/jats:title><jats:p> The application of prone positioning with acute hypoxemic respiratory failure (AHRF) or acute respiratory distress syndrome (ARDS) in non-intubation patients is increasing gradually, applying prone positioning for more high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) patients. This meta-analysis evaluates the efficacy and tolerance of prone positioning combined with non-invasive respiratory support in patients with AHRF or ARDS. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> We searched randomized controlled trials (RCTs) (prospective or retrospective cohort studies, RCTs and case series) published in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 1 July 2020. We included studies that compared prone and supine positioning with non-invasive respiratory support in awake patients with AHRF or ARDS. The meta-analyses used random effects models. The methodological quality of the RCTs was evaluated using the Newcastle\u2013Ottawa quality assessment scale. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> A total of 16 studies fulfilled selection criteria and included 243 patients. The aggregated intubation rate and mortality rate were 33% [95% confidence interval (CI): 0.26\u20130.42, I<jats:sup>2<\/jats:sup>\u2009=\u200925%], 4% (95% CI: 0.01\u20130.07, I<jats:sup>2<\/jats:sup>\u2009=\u20090%), respectively, and the intolerance rate was 7% (95% CI: 0.01\u20130.12, I<jats:sup>2<\/jats:sup>\u2009=\u20095%). Prone positioning increased PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> [mean difference (MD)\u2009=\u200947.89, 95% CI: 28.12\u201367.66; p\u2009&lt;\u20090.00001, I<jats:sup>2<\/jats:sup>\u2009=\u200967%] and SpO<jats:sub>2<\/jats:sub> (MD\u2009=\u20094.58, 95% CI: 1.35\u20137.80, p\u2009=\u20090.005, I<jats:sup>2<\/jats:sup>\u2009=\u200997%), whereas it reduced respiratory rate (MD\u2009=\u2009\u22125.01, 95% CI: \u22128.49 to \u22121.52, p\u2009=\u20090.005, I<jats:sup>2<\/jats:sup>\u2009=\u200985%). Subgroup analyses demonstrated that the intubation rate of shorter duration prone (\u2a7d5\u2009h\/day) and longer duration prone (&gt;5\u2009h\/day) were 34% and 21%, respectively; and the mortality rate of shorter duration prone (\u2a7d5\u2009h\/day) and longer duration prone (&gt;5\u2009h\/day) were 6% and 0%, respectively. PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> and SpO<jats:sub>2<\/jats:sub> were significantly improved in COVID-19 patients and non-COVID-19 patients. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> Prone positioning could improve the oxygenation and reduce respiratory rate in both COVID-19 patients and non-COVID-19 patients with non-intubated AHRF or ARDS. The reviews of this paper are available via the supplemental material section. <\/jats:p><\/jats:sec>","DOI":"10.1177\/17534666211009407","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T03:33:12Z","timestamp":1619148792000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["The efficacy and tolerance of prone positioning in non-intubation patients with acute hypoxemic respiratory failure and ARDS: a meta-analysis"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-4168","authenticated-orcid":false,"given":"Wei","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-yang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-jiao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zan-feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning 110001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-wen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 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