{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:39:29Z","timestamp":1785148769265,"version":"3.55.0"},"reference-count":48,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74\u20130.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77\u20131.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.<\/jats:p>","DOI":"10.3390\/jcm12030926","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T04:22:16Z","timestamp":1674620536000},"page":"926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-7137","authenticated-orcid":false,"given":"Huzaifa Ahmad","family":"Cheema","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9372-0362","authenticated-orcid":false,"given":"Amna","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2079-148X","authenticated-orcid":false,"given":"Sidhant","family":"Ochani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Khairpur Medical College, Khairpur 66020, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alishba","family":"Adnan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoor","family":"Sukaina","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7662-9153","authenticated-orcid":false,"given":"Ramsha","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abia","family":"Shahid","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Ebad Ur","family":"Rehman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehmat Ullah","family":"Awan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ochsner Rush Medical Center, Meridian, MS 39301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Duric","sequence":"additional","affiliation":[{"name":"Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3569-1203","authenticated-orcid":false,"given":"Brigitta","family":"Fazzini","sequence":"additional","affiliation":[{"name":"Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8643-2167","authenticated-orcid":false,"given":"Antoni","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, 08036 Barcelona, Spain"},{"name":"CibeRes (Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Respiratorias, 06\/06\/0028), Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 28029 Barcelona, Spain"},{"name":"School of Medicine, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-8844","authenticated-orcid":false,"given":"Tamas","family":"Szakmany","sequence":"additional","affiliation":[{"name":"Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK"},{"name":"Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S2213-2600(21)00175-2","article-title":"Changes in in-hospital mortality in the first wave of COVID-19: A multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK","volume":"9","author":"Docherty","year":"2021","journal-title":"Lancet Respir. 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