Coppo et al.(66 Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med. 2020;8(8):765-74.) |
Itália UC, ECP |
n = 46 pacientes. Ambos os sexos |
IET em 18 pacientes, 5 mortes não relacionadas ao procedimento |
Rosén et al.(1010 Rosén J, von Oelreich E, Fors D, Jonsson Fagerlund M, Taxbro K, Skorup P, Eby L, Campoccia Jalde F, Johansson N, Bergström G, Frykholm P; PROFLO Study Group. Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial. Crit Care. 2021;25(1):209.) |
Suécia MC, ERC |
n = 75 foram randomizados, 39 no Grupo TP e 36 no Grupo PC Ambos os sexos |
13 pacientes precisaram de IET no Grupo TP versus 12 pacientes no Grupo PC (RR 1,01; IC95% 0,46 - 2,21) |
Tonelli et al.(1313 Tonelli R, Pisani L, Tabbì L, Comellini V, Prediletto I, Fantini R, et al. Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: a retrospective multicenter cohort study. Pulmonology. 2022;28(3):181-92.) |
Itália MC, ECR |
n = 114 pacientes, 76 no Grupo TP e 38 no Grupo PC Ambos os sexos |
22 pacientes morreram (17 no Grupo TP e 5 no Grupo PC); 37 pacientes precisaram de IET (7 no Grupo PC e 30 no Grupo TP) |
Sryma et al.(1414 Sryma PB, Mittal S, Mohan A, Madan K, Tiwari P, Bhatnagar S, et al. Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy. Lung India. 2021;38(Supplement):S6-10.) |
Índia UC, não ERC |
n = 45 indivíduos (30 casos e 15 controles). Ambos os sexos |
A necessidade de VMI foi maior no Grupo Controle (33,3%) do que no Grupo Pronação (6,7%) |
Ferrando et al.(3333 Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, Ramasco F, Monedero P, Maseda E, Tamayo G, Hernández-Sanz ML, Mercadal J, Martín-Grande A, Kacmarek RM, Villar J, Suárez-Sipmann F; COVID-19 Spanish ICU Network. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care. 2020;24(1):597.) |
Espanha e Andorra MC, ECP |
n = 199 pacientes em terapia com CNAF. Ambos os sexos |
82 pacientes precisaram de IET (Grupo CNAF 60, Grupo CNAF + PC 22); 17 morreram no Grupo CNAF e 8 no Grupo CNAF + PC |
Dubosh et al.(3434 Dubosh NM, Wong ML, Grossestreuer AV, Loo YK, Sanchez LD, Chiu D, et al. Early, awake proning in emergency department patients with COVID-19. Am J Emerg Med. 2021;46:640-5.) |
Estados Unidos UC, ECP |
n = 22 pacientes. Ambos os sexos |
7 pacientes precisaram de IET (5 pacientes nas primeiras 48 horas, 2 após as 48 horas seguintes), 2 pacientes morreram |
Kaur et al.(3535 Kaur R, Vines DL, Mirza S, Elshafei A, Jackson JA, Harnois LJ, et al. Early versus late awake prone positioning in non-intubated patients with COVID-19. Crit Care. 2021;25(1):340.) |
Estados Unidos UC, ERC |
n = 125 pacientes. Desses, 92 receberam PC precoce e 33 receberam PC tardio. Ambos os sexos |
O Grupo PC precoce teve mortalidade menor do que o Grupo PC tardio (26% versus 45%; p = 0,039), sem diferença na taxa de IET. No entanto, idade avançada, IET, maior tempo para iniciar a PC e uso de hidrocortisona foram associados ao aumento da mortalidade |
Ehrmann et al.(3636 Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, Pavlov I, McNicholas B, Roca O, Mirza S, Vines D, Garcia-Salcido R, Aguirre-Avalos G, Trump MW, Nay MA, Dellamonica J, Nseir S, Mogri I, Cosgrave D, Jayaraman D, Masclans JR, Laffey JG, Tavernier E; Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med. 2021;9(12):1387-95.) |
Europa, América do Norte e América do Sul MC, ERC |
n = 1.126 pacientes, PC 567, TP 559. Incluídos 1.121 pacientes na análise IDT. Ambos os sexos |
Falha no tratamento em 40% dos pacientes no Grupo PC e 46% dos pacientes no Grupo TP (RR 0,86; IC95% 0,75 - 0,98). RR da IET 0,75 (IC95% 0,62 - 0,91), RR da mortalidade 0,87 (IC95% 0,68 - 1,11) com PC em comparação com TP aos 28 dias de inclusão no estudo |
Perez-Nieto et al.(3737 Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, Zamarron-Lopez EI, Mancilla-Galindo J, Kammar-García A, Martinez-Camacho MA, Deloya-Tomás E, Sanchez-Díaz JS, Macías-García LA, Soriano-Orozco R, Cruz-Sánchez G, Salmeron-Gonzalez JD, Toledo-Rivera MA, Mata-Maqueda I, Morgado-Villaseñor LA, Martinez-Mazariegos JJ, Flores Ramirez R, Medina-Estrada JL, Ñamendys-Silva SA; APRONOX Group. Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study. Eur Respir J. 2022;59(2):2100265.) |
México e Equador MC, ECR |
n = 827 pacientes não intubados nos grupos PC (n = 505) e TP (n = 322). Ambos os sexos |
Menos pacientes no Grupo PC precisaram de IET (23,6% versus 40,4%) ou morreram (19,8% versus 37,3%) |
Dueñas-Castell et al.(3838 Dueñas-Castell C, Borre-Naranjo D, Rodelo D, Lora L, Almanza A, Coronell W, et al. Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 in low-resource settings: a retrospective cohort study. J Intensive Care Med. 2021;36(11):1347-53.) |
Colômbia UC, ECR |
n = 212 pacientes em TP e PC. Ambos os sexos |
Mortalidade geral de 34% (73/212) |
Vianello et al.(3939 Vianello A, Turrin M, Guarnieri G, Molena B, Arcaro G, Turato C, et al. Prone positioning is safe and may reduce the rate of intubation in selected COVID-19 patients receiving high-flow nasal oxygen therapy. J Clin Med. 2021;10(15):3404.) |
Itália UC, ECP |
n = 93 pacientes foram incluídos no estudo. Ambos os sexos |
A PC foi viável e segura em 50 pacientes. Receberam IET 17 pacientes e 27 aumentaram o suporte respiratório. A taxa de mortalidade foi de 9/93. Em 41/50 dos indivíduos que passaram no estudo e foram submetidos a PC, houve benefício clínico e sobrevida sem escalonamento da terapia |
Altinay et al.(4040 Altinay M, Sayan I, Turk HS, Cinar AS, Sayın P, Yucel T, et al. Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study. Braz J Anesthesiol. 2022;72(2):194-9.) |
Turquia UC, ECR |
n = 72. Grupo PC (n = 49), analisado (n = 25). Grupo TP (n = 23), analisado (n = 23). Ambos os sexos |
Grupo PC: 9 pacientes morreram e 8 precisaram de IET (p = 0,020). Grupo TP: 16 pacientes morreram e 19 precisaram de IET (p = 0,001) |
Jayakumar et al.(4141 Jayakumar D, Ramachandran Dnb P, Rabindrarajan Dnb E, Vijayaraghavan Md BK, Ramakrishnan Ab N, Venkataraman Ab R. Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection-A multicenter feasibility randomized controlled trial. J Intensive Care Med. 2021;36(8):918-24.) |
Índia MC, ERC |
n = 60 pacientes. PC 30, TP: 30. Ambos os sexos |
Grupo PC: 3 pacientes morreram e 4 precisaram de IET. Grupo TP: 2 pacientes morreram e 4 precisaram de IET |
Solverson et al.(4242 Solverson K, Weatherald J, Parhar KK. Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Can J Anaesth. 2021;68(1):64-70.) |
Canada MC, ECR |
n = 17 pacientes. Ambos os sexos. UTI 12, ala hospitalar 5 |
7 pacientes precisaram de IET e VMI; 2 pacientes morreram na UTI após um ciclo de VMI |
Gad et al.(4343 Gad GS. Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure. Egypt J Anaesth. 2021;37(1):85-90.) |
Egito MC, ECR |
n = 30 pacientes; PC 15; VNI 15 |
6 pacientes precisaram de VMI (3 no Grupo PC e 3 no Grupo VNI); esses mesmos 6 pacientes morreram |
Burton-Papp et al.(4444 Burton-Papp HC, Jackson AI, Beecham R, Ferrari M, Nasim-Mohi M, Grocott MP, Chambers R, Dushianthan A; University Hospital Southampton Critical Care Team; REACT COVID Investigators. Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre. F1000Res. 2020;9:859.) |
Estados Unidos UC, ECR |
n = 81 pacientes; 20 pacientes receberam PC associada à VNI |
7 pacientes foram intubados; nenhum paciente morreu |
Tatlow et al.(4545 Tatlow C, Heywood S, Hodgson C, Cunningham G, Conron M, Ng HY, et al. Physiotherapy-assisted prone or modified prone positioning in ward-based patients with COVID-19: a retrospective cohort study. Physiotherapy. 2022;114:47-53.) |
Austrália UC, ECR |
n = 13 pacientes. Ambos os sexos |
7 pacientes morreram |
Bahloul et al.(4646 Bahloul M, Kharrat S, Hafdhi M, Maalla A, Turki O, Chtara K, et al. Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing. Acute Crit Care. 2021;36(3):208-14.) |
Túnez UC, ECP |
n = 21 pacientes. Ambos os sexos. Grupo PC 21, Grupo TP 17 |
7 pacientes morreram no Grupo PC e 5 no Grupo TP; 9 precisaram de VMI. A PC não foi associada a uma redução na mortalidade ou na taxa de VMI (p > 0,05 para ambos) |
Pierucci et al.(4747 Pierucci P, Ambrosino N, Di Lecce V, Dimitri M, Battaglia S, Boniello E, et al. Prolonged active prone positioning in spontaneously breathing non-intubated patients with COVID-19-associated hypoxemic acute respiratory failure with PaO2/FiO2 > 150. Front Med (Lausanne). 2021;8:626321.) |
Itália UC, ECP |
n = 32 pacientes, PC 16, VNI 16. Ambos os sexos |
5 pacientes foram intubados (3 no Grupo TP e 2 no PC), e 3 no Grupo TP morreram (os mesmos precisaram de IET) |
Winearls et al.(4848 Winearls S, Swingwood EL, Hardaker CL, Smith AM, Easton FM, Millington KJ, et al. Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: a retrospective analysis. BMJ Open Respir Res. 2020;7(1):e000711.) |
Reino Unido UC, ECR |
n = 24 pacientes com CPAP. Ambos os sexos |
1 paciente recebeu VMI e 4 pacientes morreram |
Musso et al.(4949 Musso G, Taliano C, Molinaro F, Fonti C, Veliaj D, Torti D, et al. Early prolonged prone position in noninvasively ventilated patients with SARS-CoV-2-related moderate-to-severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study. Crit Care. 2022;26(1):118.) |
Itália UC, não ERC |
n = 243 pacientes; Grupo PC 81, Grupo TP 162. Ambos os sexos |
69 pacientes morreram, 59 no Grupo TP e 10 no Grupo PC; 52 pacientes precisaram de IET, 44 no grupo controle e 8 no Grupo PC |
Aisa et al.(5050 Aisa T, Hassan T, Khan E, Algrni K, Malik MA. Efficacy and feasibility of awake proning in patients with COVID-19-related acute hypoxemic respiratory failure: an observational, prospective study. Ir J Med Sci. 2023;192(2):811-5) |
Irlanda UC, ECP |
n = 50 pacientes |
7 pacientes foram intubados (14%). A PC foi viável em 41 (82%) pacientes e 38 (76%) pacientes relataram boa tolerância |
Althunayyan et al.(5151 Althunayyan S, Almutary AM, Junaidallah MA, Heji AS, Almazroua F, Alsofayan YM, et al. Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department. J Infect Public Health. 2022;15(4):480-5.) |
Arábia Saudita UC, ECP |
n = 49 pacientes. Ambos os sexos |
6 pacientes foram intubados (12,2%) e 7 pacientes faleceram (14,3%) |
Qian et al.(5252 Qian ET, Gatto CL, Amusina O, Dear ML, Hiser W, Buie R, Kripalani S, Harrell FE Jr, Freundlich RE, Gao Y, Gong W, Hennessy C, Grooms J, Mattingly M, Bellam SK, Burke J, Zakaria A, Vasilevskis EE, Billings FT 4th, Pulley JM, Bernard GR, Lindsell CJ, Rice TW; Vanderbilt Learning Healthcare System Platform Investigators. Assessment of awake prone positioning in hospitalized adults with COVID-19: a nonrandomized controlled trial. JAMA Intern Med. 2022;182(6):612-21.) |
Estados Unidos MC, não ERC |
n = 501 pacientes designados 1:1 para o Grupo PC ou Grupo TP. Ambos os sexos |
Grupo PC: 31 pacientes foram intubados e 56 pacientes faleceram. Grupo TP: 30 foram intubados, 47 faleceram |
Fralick et al.(5353 Fralick M, Colacci M, Munshi L, Venus K, Fidler L, Hussein H, Britto K, Fowler R, da Costa BR, Dhalla I, Dunbar-Yaffe R, Branfield Day L, MacMillan TE, Zipursky J, Carpenter T, Tang T, Cooke A, Hensel R, Bregger M, Gordon A, Worndl E, Go S, Mandelzweig K, Castellucci LA, Tamming D, Razak F, Verma AA; COVID Prone Study Investigators. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ. 2022;376:e068585.) |
Canadá, Estados Unidos MC, ERC |
n = 248 pacientes; Grupo PC 126, Grupo TP 122. Ambos os sexos |
2 pacientes faleceram, 1 do Grupo PC e 1 do Grupo TP |
Barker et al.(5454 Barker J, Pan D, Koeckerling D, Baldwin AJ, West R. Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19. Postgrad Med J. 2022;98(1159):360-4.) |
Reino Unido UC, ECCR |
n = 20 pacientes; Grupo PC 10 pacientes, Grupo TP 10 pacientes. Ambos os sexos |
6 (60%) pacientes precisaram de VMI no Grupo PC e 5 (50%) no Grupo TP; 1 (10%) faleceu no Grupo PC e 4 (40%) no Grupo TP |
Esperatti et al.(5555 Esperatti M, Busico M, Fuentes NA, Gallardo A, Osatnik J, Vitali A, Wasinger EG, Olmos M, Quintana J, Saavedra SN, Lagazio AI, Andrada FJ, Kakisu H, Romano NE, Matarrese A, Mogadouro MA, Mast G, Moreno CN, Niquin GDR, Barbaresi V, Bruhn Cruz A, Ferreyro BL, Torres A; Argentine Collaborative Group on High Flow and Prone Positioning. Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study. Crit Care. 2022;26(1):16.) |
Argentina MC, ECP |
n = 335 pacientes; Grupo PC 187, Grupo TP 148. Ambos os sexos |
44 pacientes no Grupo PC (23%) e 79 (53%) no Grupo TP foram intubados; 2 pacientes faleceram, 1 de cada grupo |
Kumar et al.(5656 Kumar D, Kumar A, Kohli A, Singh R, Karthik R. Effect of prone positioning and high flow nasal oxygen on oxygenation and overall outcome in spontaneously breathing awake patient with severe COVID-19 induced acute hypoxemic respiratory failure: a prospective observational study. Trends Anaesth Crit Care. 2022;42:9-13.) |
Índia UC, ECP |
n = 67 pacientes |
NR |