Objective To evaluate the effect of awake prone positioning strategy in patients with acute hypoxemic respiratory failure（AHRF）. Methods 7 electric databases including the China National Knowledge Infrastructure（CNKI），Wanfang Database，VIP Database，PubMed，Embase，Web of Science，and Cochrane Library were systematically searched for randomized controlled trials and observations on awake prone positioning in patients with AHRF. The search time limit is from the establishment of the database to August 2022，and the references of the included literature are also traced. 2 researchers independently performed literature screening，data extraction and quality assessment according to the inclusion and exclusion criteria. Meta-analysis was performed by RevMan 5.3 software. Results 12 pieces of the literature were finally included，including 5 randomized controlled trials and 7 cohort studies，with a total of 2 632 patients. The results of Meta-analysis showed that the intubation rate of the awake prone positioning group was significantly different from that of the routine care group[RR=0.73，95%CI （0.65，0.82），P<0.001]；compared with those of the routine care group，the differences of the mortality rate[RR=0.87，95%CI(0.74，1.03), P=0.110] and hospital stay[MD=-1.05，95%CI(-4.22, 2.12),P=0.520] were not statistically significant. The secondary adverse effects to awake prone positioning were reported in 7 studies, including discomfort(8%~35%),pain(7%~11%),vomiting(2%~8%),catheter displacement(4%~6%),skin ulceration(0.4%~4.0%),hypotension(4%),venous thromboembolism(2.3%),cough(2%),and aspiration pneumonia(1.5%). The time range of a single prone position of the patients was quite different(1.25~15.00) h. Conclusion Awake prone positioning can effectively reduce the intubation rate of AHRF patients，but it cannot reduce the hospital stay of patients，and the impact on mortality needs further research and verification. Intolerance and pain were the most common adverse reactions when patients were in the prone position，affecting their compliance. Therefore，it is suggested that high-quality research should be carried out in the future，aiming at strengthening nursing management of awake prone positioning，improving patient compliance，and further improving the success rate of treatment.
