Clinical benefits of prone positioning in the treatment of non-intubated patients with acute hypoxic respiratory failure: a rapid systematic review

Emerg Med J. 2021 Aug;38(8):594-599. doi: 10.1136/emermed-2020-210586. Epub 2021 Jun 23.


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.

Keywords: pneumonia/infections; respiratory.

Publication types

  • Systematic Review

MeSH terms

  • COVID-19 / therapy*
  • Humans
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Prone Position*
  • Respiratory Insufficiency / therapy*
  • Respiratory Insufficiency / virology
  • SARS-CoV-2