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Clinical benefits of prone positioning in the treatment of non-intubated patients with acute hypoxic respiratory failure: a rapid systematic review
  1. Hayden Richards1,2,
  2. Karen Robins-Browne1,
  3. Troy O'Brien1,
  4. Greer Wilson1,
  5. Jeremy Furyk1,2
  1. 1 Emergency Medicine, University Hospital Geelong, Geelong, Victoria, Australia
  2. 2 School of Medicine, Deakin University Faculty of Health Medicine Nursing and Behavioural Sciences, Geelong, Victoria, Australia
  1. Correspondence to Dr Hayden Richards, Emergency Medicine, University Hospital Geelong, Geelong, Victoria 3220, Australia; haydenr{at}


Background The COVID-19 pandemic has led to a surge in critically unwell patients with type 1 respiratory failure. In an attempt to reduce the number of patients requiring mechanical ventilation, prone positioning (PP) of non-intubated patients has been added to many hospital guidelines around the world. We set out to conduct a systematic review of the evidence relating to PP in the non-intubated patient with type 1 respiratory failure secondary to COVID-19 and other causes.

Methods The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search of major databases and grey sources was conducted. Studies were assessed for inclusion by two authors according to prespecified criteria. Data collection processes, analysis and risk of bias assessment were planned.

Results 31 studies were included for analysis. These consisted of prospective and retrospective case series, cohort studies and case reports. None of the studies included a comparison group. No statistical analysis was performed. Descriptive data of included studies and narrative synthesis are presented.

Conclusions No high-quality randomised controlled trials were found and thus evidence in relation to PP as a treatment for non-intubated patients with type 1 respiratory failure is lacking.

  • respiratory
  • pneumonia/infections

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  • Handling editor Ed Benjamin Graham Barnard

  • Contributors Dr HR and Dr TO’B were primarily involved in the inclusion/exclusion and analysis of the reviewed papers. Dr KR-B and Dr GW created the protocol for the planned quantitative analysis of the included papers. JF provided oversight, guidance and arbitration throughout. All authors contributed to the writing and editing of the manuscript. Research librarian, SH, is acknowledged as an important contributor for assisting with the literature search.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.