Publication date: May 28, 2026
Acute hypoxemic respiratory failure (AHRF) is a major cause of morbidity and mortality and often requires advanced respiratory support. Awake prone positioning (APP) has emerged as a simple, low-cost intervention to improve oxygenation in non-intubated patients; however, its clinical effectiveness and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of awake prone positioning in non-intubated adult patients with acute hypoxemic respiratory failure. A systematic search of PubMed, Scopus, and Web of Science was conducted from database inception to February 2026. Randomized controlled trials and observational comparative studies evaluating APP versus usual care were included. Primary outcomes were mortality, intubation, and length of hospital stay. Secondary outcomes included ICU stay, invasive mechanical ventilation, ICU admission, escalation of respiratory support, time to invasive ventilation, and adverse events. Risk of bias was assessed using ROB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed using a random-effects model. Twenty-four studies involving 6,164 patients were included. APP significantly reduced mortality (OR = 0. 60, 95% CI 0. 42-0. 86, p = 0. 005), intubation (OR = 0. 69, 95% CI 0. 60-0. 79, p
Open Access PDF
| Concepts | Keywords |
|---|---|
| Anesthesiol | Awake prone positioning |
| February | COVID-19 |
| Morbidity | Intubation |
| Rob | Mechanical ventilation |
| Stay | Meta-analysis |
| Mortality |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | acute hypoxemic respiratory failure |
| disease | MESH | included |
| pathway | REACTOME | Reproduction |
| drug | DRUGBANK | Coenzyme M |
| disease | MESH | COVID 19 |
| drug | DRUGBANK | Oxygen |
| disease | MESH | acute respiratory distress syndrome |
| disease | MESH | lung injury |
| disease | MESH | hypoxemia |
| disease | MESH | clinical deterioration |
| disease | MESH | ventilator induced lung injury |
| disease | MESH | strain |
| disease | MESH | vomiting |
| disease | MESH | cardiac arrest |
| disease | MESH | death |
| disease | MESH | SaO |
| drug | DRUGBANK | Carbon dioxide |
| drug | DRUGBANK | Trimebutine |
| disease | MESH | MAE |
| disease | MESH | pain |
| disease | MESH | Dis |
| disease | MESH | Critical Illness |
| disease | MESH | Roca |
| drug | DRUGBANK | Spinosad |
| disease | MESH | Pneumonia |
| disease | MESH | Infection |
| drug | DRUGBANK | Carboxyamidotriazole |