In this prospective meta-analysis of observational studies of patients with acute hypoxemic respiratory failure due to COVID-19, APP did not result in lower intubation or mortality rates, despite reported improvements in oxygenation parameters.

Data from randomized controlled trials are needed. Routine implementation of APP outside of a clinical trial is not supported by current evidence.

This systematic review and meta-analysis is a summation of methodologically flawed studies (which are the best evidence available at this time), however the conclusions drawn from them should also be taken with a grain of salt.

All the included trials were small, observational, had wide confidence intervals and high heterogeneity between studies making the interpretation of this review an absence of evidence, rather than absence of benefit.

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