Sowmyashree Kota Karanth, Saajid Z Azhar, Maria J Corrales-Martinez, Vijay Krishnamoorthy, Pattrapun T Wongsripuemtet, Julien Cobert, Mona Hashemaghaie, Karthik Raghunathan
{"title":"培养对COVID-19急性呼吸窘迫综合征成人醒卧位益处的影响：系统综述和荟萃分析","authors":"Sowmyashree Kota Karanth, Saajid Z Azhar, Maria J Corrales-Martinez, Vijay Krishnamoorthy, Pattrapun T Wongsripuemtet, Julien Cobert, Mona Hashemaghaie, Karthik Raghunathan","doi":"10.1097/EA9.0000000000000068","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Randomised controlled trials (RCTs) conducted early during the pandemic showed that awake prone positioning (APP) significantly reduced the risk of intubation among adults with COVID-19 acute respiratory distress syndrome (ARDS), but more recent studies have questioned this benefit. We hypothesise that the effects of APP may vary with the national Power Distance Index (PDI), a measure of hierarchy in local culture.</p><p><strong>Objective: </strong>To conduct a meta-analysis examining the effects of APP in adults with COVID-19 ARDS and examine whether effects differ between nations with a PDI less than 80 versus at least 80 (low versus high deference to authority).</p><p><strong>Design: </strong>Systematic review and meta-analysis of RCTs.</p><p><strong>Data sources: </strong>Cumulated Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Medline and Scopus were searched to November 2024.</p><p><strong>Eligibility criteria: </strong>All RCTs that compared APP with standard care in adults with COVID-19-related ARDS or Acute Hypoxaemic Respiratory Failure (AHRF) were included.</p><p><strong>Results: </strong>Twenty-two RCTs were identified with 3615 patients having valid data. APP reduced the risk of intubation [relative risk (RR) 0.80, 95% confidence interval (CI), 0.72 to 0.90]. Effects were greater in nations with a PDI at least 80 (RR 0.67, 95% CI, 0.54 to 0.82), and there was equipoise in nations with a PDI less than 80 (RR 0.89, 95% CI, 0.75 to 1.05). Intubation rates in the high PDI nations decreased from 32.3% (<i>n</i> = 512) with standard care to 21.2% (<i>n</i> = 508) with APP. The reduction in intubations with APP was less pronounced in nations with low PDI, from 20.1% (<i>n</i> = 1012) with standard care to 17.1% (<i>n</i> = 1084). The risk of mortality reduced with APP (RR 0.86, 95% CI, 0.74 to 0.99). Fidelity of APP, specifically, adherence to the recommended duration, was higher in nations with PDI at least 80 (<i>P</i> = 0.04).</p><p><strong>Conclusion: </strong>APP reduces the risk of intubation and mortality, but the significance of this benefit varies with the cultural context. Effects are strong in nations with a higher PDI, where intubation rates are lower and adherence to APP higher.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"4 2","pages":"e0068"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977753/pdf/","citationCount":"0","resultStr":"{\"title\":\"The effect of culture on the benefits of awake prone positioning for adults with COVID-19 acute respiratory distress syndrome: A systematic review and meta-analysis.\",\"authors\":\"Sowmyashree Kota Karanth, Saajid Z Azhar, Maria J Corrales-Martinez, Vijay Krishnamoorthy, Pattrapun T Wongsripuemtet, Julien Cobert, Mona Hashemaghaie, Karthik Raghunathan\",\"doi\":\"10.1097/EA9.0000000000000068\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Randomised controlled trials (RCTs) conducted early during the pandemic showed that awake prone positioning (APP) significantly reduced the risk of intubation among adults with COVID-19 acute respiratory distress syndrome (ARDS), but more recent studies have questioned this benefit. We hypothesise that the effects of APP may vary with the national Power Distance Index (PDI), a measure of hierarchy in local culture.</p><p><strong>Objective: </strong>To conduct a meta-analysis examining the effects of APP in adults with COVID-19 ARDS and examine whether effects differ between nations with a PDI less than 80 versus at least 80 (low versus high deference to authority).</p><p><strong>Design: </strong>Systematic review and meta-analysis of RCTs.</p><p><strong>Data sources: </strong>Cumulated Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Medline and Scopus were searched to November 2024.</p><p><strong>Eligibility criteria: </strong>All RCTs that compared APP with standard care in adults with COVID-19-related ARDS or Acute Hypoxaemic Respiratory Failure (AHRF) were included.</p><p><strong>Results: </strong>Twenty-two RCTs were identified with 3615 patients having valid data. APP reduced the risk of intubation [relative risk (RR) 0.80, 95% confidence interval (CI), 0.72 to 0.90]. Effects were greater in nations with a PDI at least 80 (RR 0.67, 95% CI, 0.54 to 0.82), and there was equipoise in nations with a PDI less than 80 (RR 0.89, 95% CI, 0.75 to 1.05). Intubation rates in the high PDI nations decreased from 32.3% (<i>n</i> = 512) with standard care to 21.2% (<i>n</i> = 508) with APP. The reduction in intubations with APP was less pronounced in nations with low PDI, from 20.1% (<i>n</i> = 1012) with standard care to 17.1% (<i>n</i> = 1084). The risk of mortality reduced with APP (RR 0.86, 95% CI, 0.74 to 0.99). Fidelity of APP, specifically, adherence to the recommended duration, was higher in nations with PDI at least 80 (<i>P</i> = 0.04).</p><p><strong>Conclusion: </strong>APP reduces the risk of intubation and mortality, but the significance of this benefit varies with the cultural context. Effects are strong in nations with a higher PDI, where intubation rates are lower and adherence to APP higher.</p>\",\"PeriodicalId\":520410,\"journal\":{\"name\":\"European journal of anaesthesiology and intensive care\",\"volume\":\"4 2\",\"pages\":\"e0068\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977753/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of anaesthesiology and intensive care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/EA9.0000000000000068\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of anaesthesiology and intensive care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/EA9.0000000000000068","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
The effect of culture on the benefits of awake prone positioning for adults with COVID-19 acute respiratory distress syndrome: A systematic review and meta-analysis.
Background: Randomised controlled trials (RCTs) conducted early during the pandemic showed that awake prone positioning (APP) significantly reduced the risk of intubation among adults with COVID-19 acute respiratory distress syndrome (ARDS), but more recent studies have questioned this benefit. We hypothesise that the effects of APP may vary with the national Power Distance Index (PDI), a measure of hierarchy in local culture.
Objective: To conduct a meta-analysis examining the effects of APP in adults with COVID-19 ARDS and examine whether effects differ between nations with a PDI less than 80 versus at least 80 (low versus high deference to authority).
Design: Systematic review and meta-analysis of RCTs.
Data sources: Cumulated Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Medline and Scopus were searched to November 2024.
Eligibility criteria: All RCTs that compared APP with standard care in adults with COVID-19-related ARDS or Acute Hypoxaemic Respiratory Failure (AHRF) were included.
Results: Twenty-two RCTs were identified with 3615 patients having valid data. APP reduced the risk of intubation [relative risk (RR) 0.80, 95% confidence interval (CI), 0.72 to 0.90]. Effects were greater in nations with a PDI at least 80 (RR 0.67, 95% CI, 0.54 to 0.82), and there was equipoise in nations with a PDI less than 80 (RR 0.89, 95% CI, 0.75 to 1.05). Intubation rates in the high PDI nations decreased from 32.3% (n = 512) with standard care to 21.2% (n = 508) with APP. The reduction in intubations with APP was less pronounced in nations with low PDI, from 20.1% (n = 1012) with standard care to 17.1% (n = 1084). The risk of mortality reduced with APP (RR 0.86, 95% CI, 0.74 to 0.99). Fidelity of APP, specifically, adherence to the recommended duration, was higher in nations with PDI at least 80 (P = 0.04).
Conclusion: APP reduces the risk of intubation and mortality, but the significance of this benefit varies with the cultural context. Effects are strong in nations with a higher PDI, where intubation rates are lower and adherence to APP higher.
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