TY  - JOUR
A1  - Schmid, Benedikt
A1  - Griesel, Mirko
A1  - Fischer, Anna-Lena
A1  - Romero, Carolina S.
A1  - Metzendorf, Maria-Inti
A1  - Weibel, Stephanie
A1  - Fichtner, Falk
T1  - Awake prone positioning, high-flow nasal oxygen and non-invasive ventilation as non-invasive respiratory strategies in COVID-19 acute respiratory failure: a systematic review and meta-analysis
T2  - Journal of Clinical Medicine
N2  - Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.
KW  - respiratory failure
KW  - non-invasive ventilation
KW  - high-flow nasal cannula
KW  - awake prone positioning
KW  - COVID-19
KW  - systematic review
Y1  - 2022
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/25522
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-255225
SN  - 2077-0383
VL  - 11
IS  - 2
ER  -