Reply to: Awake prone positioning in non-intubated patients with acute hypoxemic respiratory failure due to COVID-19: A systematic review of proportional outcomes comparing observational studies with and without awake prone positioning in the setting of COVID-19.

2021 ◽  
pp. respcare.09547
Author(s):  
Javier Mancilla-Galindo ◽  
Ashuin Kammar-García ◽  
Eder I. Zamarrón-López ◽  
Manuel A. Guerrero-Gutiérrez ◽  
Diego Escarramán-Martínez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Observational Studies ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

scholarly journals Awake prone positioning in non-intubated patients with acute hypoxemic respiratory failure due to COVID-19: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ivan Pavlov ◽  
Hangyong He ◽  
Bairbre McNicholas ◽  
Yonatan Perez ◽  
Elsa Tavernier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Observational Studies ◽  
Meta Analysis ◽  
Current Evidence ◽  
Intubation Rate ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Randomized Controlled

Abstract Background: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubations of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP.Methods: We performed a systematic review and meta-analysis of observational studies to compare oxygenation parameters in-hospital intubation rate in patients treated with APP or with standard care.Results: A total of 46 published and 4 unpublished observational studies that included 2994 patients were included. APP was associated with significant improvement of various oxygenation parameters in 19 studies (n=381) that reported this outcome. The intubation rate was 27% (95%CI, 19 to 37%) in the 870 patients treated with APP, as compared to 30% (95%CI, 20 to 42%) in the 852 patients treated with usual care (p=0.71).Conclusions: On the basis of the available evidence, it is not possible to demonstrate efficacy of APP for patients with COVID-19 acute respiratory failure, as assessed by the need for invasive ventilation. Routine implementation of APP outside of a clinical trial is not supported by current evidence. Randomized controlled clinical studies are urgently needed to definitively assess the utility of APP in these patients.Registered on PROSPERO on August 3d, 2020, CRD42020201947.

scholarly journals Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Ivan Pavlov ◽  
Hangyong He ◽  
Bairbre McNicholas ◽  
Yonatan Perez ◽  
Elsa Tavernier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Usual Care ◽  
Observational Studies ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Current Evidence ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Abstract Background: Awake prone positioning (APP) has been advocated to improve oxygenation and prevent intubations of patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). This paper aims to synthesize the available evidence on the efficacy of APP. Methods: We performed a prospective systematic review and meta-analysis of observational studies to compare in-hospital intubation and mortality rates in patients treated with APP or with standard care.Results: A total of 46 published and 4 unpublished observational studies that included 2994 patients were included. The intubation rate was 27% (95%CI, 19 to 37%) in the 870 patients treated with APP, as compared to 30% (95%CI, 20 to 42%) in the 852 patients treated with usual care (p=0.71). The mortality rate was 11% (95CI%, 6 to 20%) in the 767 patients treated with APP, as compared to 22% (95%CI, 13 to 36%) in those treated with usual care. This difference was not statistically significant (p=0.10). APP was associated with significant improvement of various oxygenation parameters in 19 studies (n=381) that reported this outcome.Conclusions: In this prospective meta-analysis of observational studies of patients with acute hypoxemic respiratory failure due to COVID-19, APP did not result in lower intubation or mortality rates, despite reported improvements in oxygenation parameters. Data from randomized controlled trials are needed. Routine implementation of APP outside of a clinical trial is not supported by current evidence. Registered on PROSPERO on August 3d, 2020, CRD42020201947.

Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis. Response to letter

2019 ◽  
Vol 50 ◽  
pp. 310
Author(s):  
Paula G. David-João ◽  
Murilo H. Guedes ◽  
Alvaro Réa-Neto ◽  
Viviane B. de Oliveira Chaiben ◽  
Cristina P. Baena
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Meta Analysis ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis

2019 ◽  
Vol 49 ◽  
pp. 84-91 ◽  
Author(s):  
Paula G. David-João ◽  
Murilo H. Guedes ◽  
Álvaro Réa-Neto ◽  
Viviane B. de Oliveira Chaiben ◽  
Cristina P. Baena
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Meta Analysis ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

2020 ◽  
Vol 54 ◽  
Author(s):  
Cary Amiel G. Villanueva ◽  
Marie Gene D. Cruz ◽  
Lia M. Palileo-Villanueva
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document