EFFECTIVENESS OF AWAKE PRONE POSITIONING IN NON-INTUBATED ADULTS WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE AN UPDATED SYSTEMATIC REVIEW AND QUANTITATIVE DESCRIPTIVE SYNTHESIS

Awake prone positioning is a low-cost intervention intended to improve ventilation–perfusion matching and oxygenation while avoiding invasive ventilation. Its effect depends on patient selection, timing, duration, respiratory-support modality, adherence, tolerance, and rapid recognition of failure. Objective: To evaluate the effectiveness, safety, and implementation implications of the specified noninvasive respiratory-support strategy in adults with acute hypoxemic respiratory failure. Methods: This PRISMA 2020-aligned updated systematic-review draft maps PubMed-indexed and publisher-verified evidence available through 29 August 2026. Comparative trials, evidence syntheses, and relevant Saudi/GCC implementation studies were extracted. Heterogeneous populations, comparators, and outcome definitions precluded a new pooled meta-analysis; published estimates are displayed descriptively. Results: Eight core reports were mapped. The 2025 IPD meta-analysis of 14 RCTs and 3,019 patients reported lower intubation (OR 0.70, 95% CI 0.59–0.84), lower hospital mortality (OR 0.77, 0.63–0.95), and improved survival without intubation (OR 1.42, 1.20–1.68). Benefit appeared greater with early and sustained positioning, while adherence and tolerance limited several trials. Saudi studies mainly demonstrated feasibility and short-term physiologic improvement. Conclusion: Awake prone positioning probably reduces intubation in selected adults with COVID-19-related acute hypoxemic respiratory failure, and the most recent IPD evidence suggests a modest mortality benefit.