Effect of Prone Positioning on the Respiratory Support of Nonintubated Patients With COVID-19 and Acute Hypoxemic Respiratory Failure

Abstract

COVID-19-associated respiratory illness may lead to ARDS. 1 In intubated patients with severe ARDS, early, prolonged, and repeated sessions of prone positioning (PP) decrease mortality rates. 2,3 Awake PP is feasible, improves oxygenation in some patients, and may prevent respiratory worsening, [4][5][6] The main objective of the present study was to evaluate the effect of PP on the outcome of spontaneously breathing patients with COVID-19 with acute respiratory failure. MethodsWe designed an exposed/nonexposed bicentric retrospective matched cohort study to assess the effectiveness of PP for patients hospitalized outside ICU with COVID-19 whose condition required oxygen.

Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study

“…After the search of the literature, 99 records were retrieved, of which only 9 studies [10][11][12][19][20][21][22][23][24] were observational comparison-group studies including both AP and supine patients, with sufficient information to calculate the overall risk of intubation, which are summarised alongside the APRONOX study in Figure 3; the funnel plot is provided as Appendix 9.…”

Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19

“…Four RCTs 6,20,22,23 were of moderate quality, and one RCT 17 was of high quality. Six observational studies 5,13,15,16,19,21 had a total score >6, indicating that they were of high quality. Three observational studies 14,18,24 scored 6, indicating that they were of moderate quality.…”

Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial

“… 4 , 5 , 6 , 7 Awake prone positioning has been associated with improved oxygenation in observational studies of non-intubated patients with acute respiratory distress syndrome 8 and, more recently, in patients with severe COVID-19. 9 , 10 , 11 Two small (n=30 and n=60) pilot trials studied the feasibility of awake prone positioning in non-intubated patients but did not have the power to show improvement in oxygenation, escalation of respiratory support, or mortality. 12 , 13 Despite the paucity of large scale randomised controlled evidence evaluating patient-centred outcomes, awake prone positioning generated great interest in the clinical and scientific communities, and it has been incorporated into clinical guidelines 14 and expert consensus statements.…”