Table 1.
Source; trial design | No of participants | Population | Location at enrolment | No (%) women | Median (IQR) baseline oxygenation | Prone positioning intervention | Control | Primary outcome | Follow-up duration | Median (IQR) duration of prone positioning (intervention group) | |
---|---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | ||||||||||
Alhazzani (Canada, USA, Kuwait, and Saudi Arabia) 2022; RCT | 400 | Suspected or confirmed covid-19. Requiring NP, HFNC, or NIV with a FiO2 ≥40% | HDU and ICU | 117 (29) | S/F 132 (103-174) | S/F 136 (110-181) | 8-10 hours/day | Usual care | Endotracheal intubation | 30 days | 5 (2-8) hours/day (≤4 days) |
Ehrmann (Canada) 2021; MT-RCT | 13 | Confirmed covid-19. Requiring HFNC, P/F <300 | Medical ward, HDU, and ICU* | 6 (46) | S/F 169.3 (68.1) | S/F 166.8 (86.5) | As tolerated, and HFNC | HFNC+usual care | Composite: Endotracheal intubation or death | 28 days | 2.4 (1.7-3.0) hours/day (≤14 days) |
Ehrmann (France) 2021; MT-RCT | 402 | Confirmed covid-19 Requiring HFNC and P/F <300 | ICU | 100 (25) | S/F 155.2 (48.3) | S/F 155.8 (44.6) | As tolerated, and HFNC | HFNC+usual care | Composite: Endotracheal intubation or death | 28 days | 2.0 (1.0-3.7) hours/day (≤14 days) |
Ehrmann (Ireland) 2021; MT-RCT | 24 | Confirmed covid-19. Requiring HFNC or venturi mask with SpO2 <94% | Medical ward, HDU, and ICU* | 8 (33) | S/F 193.9 (45.5) | S/F 178.3 (52.7) | As tolerated | Usual care | Composite: Endotracheal intubation or death | 28 days | 3.1 (2.1-3.9) hours/day (≤14 days) |
Ehrmann (Mexico) 2021; MT-RCT | 430 | Confirmed covid-19. Requiring HFNC with FiO2 ≥30% to maintain SpO2 ≥90% | Medical ward, HDU, and ICU* | 172 (40) | S/F 134.7 (38.7) | S/F 135.5 (37.9) | As tolerated, and HFNC | HFNC+usual care | Composite: Endotracheal intubation or death | 28 days | 8.6 (6.1-11.4) hours/day (≤14 days) |
Ehrmann (Spain) 2021; MT-RCT | 30 | Confirmed covid-19. Requiring HFNC and P/F<300 | ICU | 7 (23) | S/F 162.9 (22.8) | S/F 155.8 (30.7) | As tolerated, and HFNC | HFNC+usual care | Composite: Endotracheal intubation or death | 28 days | 1.6 (1.1-2.3) hours/day (≤14 days) |
Ehrmann (USA) 2021; MT-RCT | 222 | Confirmed covid-19. Requiring HFNC ≥50 L/min to maintain SpO2 92-95% and P/F<200 or S/F<240 | Medical ward, HDU, and ICU* | 82 (37) | S/F 152 (37.8) | S/F 156 (40.6) | As tolerated and HFNC | HFNC+usual care | Composite: Endotracheal intubation or death | 28 days | 2.5 (0.7-6.9) hours/day (≤14 days) |
Fralick (Canada and USA) 2021; RCT | 248 | Suspected covid-19 Requiring supplemental oxygen <50% FiO2 | Medical ward | 89 (36) | S/F 303 (261-336) | S/F 305 (267-339) | 2 hours/session, 4 times/day, encouraged while sleeping | Usual care | Composite: In-hospital death, endotracheal intubation, NIV, or FiO2 ≥60% for 24 hours | 30 days | 6 (1.5-12.8) hours/72 hours (≤72 hours) |
Rampon (USA and Spain) 2022; RCT | 293 | Suspected covid-19. Requiring <6 L/min supplemental oxygen | Medical ward | 117 (40) | S/F 396 (308-457) | S/F 402 (311-457) | 12 hours/day | Usual care | Composite: Respiratory deterioration (>2 L/min increase oxygen) or switch to different oxygen mode or ICU transfer | 14 days | 35.7% adhered to prone positioning >6 hours at least once |
Harris (Qatar) 2022; RCT | 61 | Suspected covid-19. SpO2 <94% or supplemental oxygen >5 L/min | Medical ward | 7 (11) | S/F 196 (165-245) | S/F 196 (182-240) | >3 hours to <16 hours/day | Usual care | Escalation of respiratory support | 30 days | NR |
Hashemian (Iran) 2021; RCT | 75 | Confirmed covid-19. Treated with NIV, P/F <300 | ICU | 23 (31) | Severity of P/F: mild, 233.1 (15.7); moderate, 138.4 (18.5); severe, 76.9 (13.0) | Severity of PF: mild, 213.4 (14.9); moderate, 150.7 (17.7); severe: 79.6 (13.3) | 30 minutes every 4 hours, and NIV | Usual care and NIV | PaO2/FiO2 | 24 hours | NR |
Jayakumar (India) 2021; RCT | 60 | Suspected covid-19. Requiring ≥4 L oxygen for SpO2 ≥92% or a P/F 100-300 and PaCO2 <45 mm Hg | ICU | 10 (17) | P/F 233.2 (118.8) | P/F 185.6 (126.1) | 6 hours/day | Usual care | Protocol adherence | 7 days | Maximum session for prone positioning, 2 (1-3) hours (≤7 days) |
Johnson (USA) 2021; RCT | 30 | Suspected covid-19. Admitted to hospital <48 hours | Medical ward | 14 (47) | S/F NR. FiO2 21% (21-29%) | S/F NR. FiO2 21% (21-29%) | 1-2 hours every 4 hours, or as tolerated | Usual care | Change in PaO2/FiO2 | 72 hours | 1.6 (0.2-3.1) hours/72 hours |
Kharat (Switzerland) 2021; C-RCT | 27 | Confirmed covid-19. With NP 1-6 L/min to maintain SpO2 90-92% | Medical ward | 10 (37) | S/F 318 (284-341) | S/F 336 (303-388) | 12 hours/day | Usual care | Oxygen flow rate requirement | 24 hours | 4.9 (2.6) hours/day (≤24 hours) |
Qian 2022 (USA); Q-RCT | 501 | Confirmed covid-19. Requiring supplemental oxygen for SpO2 ≥89% | Medical ward and ICU | 217 (43) | S/F NR. Low flow oxygen (n=170) | S/F NR. Low flow oxygen (n=162) | As tolerated | Usual care | Highest level of oxygen support on the day 5 after enrollment (WHO COVID-19 Ordinal Outcome Scale) | 5 days | 4.2 (1.8-6.7) hours/day (≤5 days) |
Rosén (Sweden) 2021; RCT | 75 | Confirmed covid-19. Requiring HFNC or NIV with a P/F ≤150 for >1 hour | Medical ward and ICU | 20 (27) | S/F 151 (131-174) | S/F 157 (136-175) | 16 hours/day | Usual care | Endotracheal intubation | 30 days | 9.0 (4.4-10.6) hours/day (≤72 hours) |
Taylor 2021 (USA); C-RCT | 40 | Confirmed covid-19 with SpO2 <93% or requiring ≥3 L/min oxygen | Medical ward | 13 (33) | S/F NR. NP <4 L/ min (n=15) | S/F NR. NP <4 L/ min (n=7) | As tolerated | Usual care | Implementation outcome framework | NR | No of participants attempting awake prone positioning, ≤48 hours (n=10) |
ARDS=acute respiratory distress syndrome; C-RCT=cluster randomized controlled trial; FiO2=fraction of inspired oxygen; HDU=high dependency unit; HFNC=high flow nasal cannula; ICU=intensive care unit; IQR=interquartile range; MT-RCT=randomized controlled meta-trial; NIV=non-invasive ventilation; NP=nasal prongs; NR=not reported; PaO2=partial pressure of arterial oxygen; P/F=PaO2:FiO2 ratio; Q-RCT=quasi randomized controlled trial; S/F=SpO2:FiO2 ratio; RCT=randomized controlled trial; SpO2=oxygen saturation; WHO=World Health Organization.
Location at enrollment not specified by trial site.