Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure

Jan. 17, 2022

Awake prone positioning has been reported to improve oxygenation for patients with COVID-19 in retrospective and observational studies, but whether it improves patient-centered outcomes is unknown, according to a new study released by the Lancet.

The study was to evaluate the efficacy of awake prone positioning to prevent intubation or death in patients with severe COVID-19 in a large-scale randomized trial. Awake prone positioning of patients with hypoxaemic respiratory failure due to COVID-19 reduces the incidence of treatment failure and the need for intubation without any signal of harm. These results support routine awake prone positioning of patients with COVID-19 who require support with high-flow nasal cannula.

Adults who required respiratory support with high-flow nasal cannula for acute hypoxaemic respiratory failure due to COVID-19 were randomly assigned to awake prone positioning or standard care. Hospitals from six countries were involved: Canada, France, Ireland, Mexico, USA, Spain.

Severe illness characterized by progressive hypoxaemic respiratory failure develops in a large number of patients with COVID-19, resulting in the need for invasive mechanical ventilation.

In patients who are intubated and have moderate to severe acute respiratory distress syndrome, prone positioning is an effective intervention to improve oxygenation and reduce mortality.

The Lancet release