Prevalence of adverse events in pronated intubated adult COVID-19 patients: A systematic review with meta-analysis

Daiane Gabiatti, Leticia Genova Vieira, Amanda Salles Margatho, Bruna Nogueira dos Santos, Alexander Mark Clark, Christiane Inocêncio Vasques, Renata Cristina De Campos Pereira Silveira

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Aim: To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients. Design: A systematic review and meta-analysis. Data sources: This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources. Methods: The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%). Conclusion: The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction. Implications for the patient care: The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients. Impact: This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units. Reporting method: This systematic review adhered to the PRISMA reporting guideline. Patient or public contribution: As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.

Original languageEnglish
Pages (from-to)58-75
Number of pages18
JournalJournal of Clinical Nursing
Issue number1
Publication statusPublished - Jan. 2024


  • COVID-19
  • adverse events
  • pronation


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