Effectiveness of Prolonged Awake Prone Positioning in Preventing Intubation among Less Severely Patients with COVID-19-Related Acute Hypoxemic Respiratory Failure

<bold>Background:</bold> Research indicates the utilization of Awake Prone Positioning (APP) as a potential strategy to mitigate the risk of endotracheal intubation in COVID-19 patients experiencing respiratory difficulties. However, the efficacy of prolonged APP durations, particularly in less severe cases, remains uncertain. <bold>Objective:</bold> This study aims to investigate whether extended periods of APP can diminish the necessity for intubation in individuals with milder COVID-19 symptoms and respiratory issues. Method: A systematic review was conducted on studies published between January 2020 and October 2022, focusing on APP implementation in COVID-19 patients. Subgroups were categorized based on the duration of APP (<3 hours, 3-6 hours, ≥6 hours). Result: Among the 14 studies meeting the inclusion criteria, those with APP durations of ≥6 hours exhibited a decreased risk of intubation (RR 0.70 [0.60–0.83]; p< 0.0001). Conversely, shorter durations of APP did not significantly reduce the risk (<3 hours: RR 2.00 [95% CI 0.20–19.78]; p= 0.55; 3-6 hours: RR 0.77 [0.45–1.33]; p= 0.35). Overall, APP was associated with a decreased risk of intubation (RR 0.72 [95% CI 0.60-0.83]; p= 0.0003), albeit with notable statistical heterogeneity(I2 =68%; χ2= 34.81; p=0.0003). <bold>Conclusion:</bold> Prolonged durations of APP (≥6 hours) demonstrated notable effectiveness in reducing the risk of intubation in less severe cases of COVID-19. Further ongoing trials are imperative for confirming these findings.