• Ee Xin Chua, Syed Mohd Ikhmal Syed Mohd Zahir, Ka Ting Ng, Wan Yi Teoh, Mohd Shahnaz Hasan, Shairil Rahayu Binti Ruslan, and Mohammed F Abosamak.
• Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
• J Clin Anesth. 2021 Nov 1; 74: 110406110406.

Study ObjectiveTo review the effects of prone position and supine position on oxygenation parameters in patients with Coronavirus Disease 2019 (COVID-19).DesignSystematic review and meta-analysis of non-randomized trials.PatientsDatabases of EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until March 2021.InterventionsCOVID-19 patients being positioned in the prone position either whilst awake or mechanically ventilated.MeasurementsPrimary outcomes were oxygenation parameters (PaO₂/FiO₂ ratio, PaCO₂, SpO₂). Secondary outcomes included the rate of intubation and mortality rate.ResultsThirty-five studies (n = 1712 patients) were included in this review. In comparison to the supine group, prone position significantly improved the PaO₂/FiO₂ ratio (study = 13, patients = 1002, Mean difference, MD 52.15, 95% CI 37.08 to 67.22; p < 0.00001) and SpO₂ (study = 11, patients = 998, MD 4.17, 95% CI 2.53 to 5.81; p ≤0.00001). Patients received prone position were associated with lower incidence of mortality (study = 5, patients = 688, Odd ratio, OR 0.44, 95% CI 0.24 to 0.80; p = 0.007). No significant difference was noted in the incidence of intubation rate (study = 5, patients = 626, OR 1.20, 95% CI 0.77 to 1.86; p = 0.42) between the supine and prone groups.ConclusionOur meta-analysis demonstrated that prone position improved PaO₂/FiO₂ ratio with better SpO₂ than supine position in COVID-19 patients. Given the limited number of studies with small sample size and substantial heterogeneity of measured outcomes, further studies are warranted to standardize the regime of prone position to improve the certainty of evidence. PROSPERO Registration: CRD42021234050.Copyright © 2021 Elsevier Inc. All rights reserved.

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