A randomised clinical trial of awake prone positioning in COVID-19 suspects with acute hypoxemic respiratory failure

• DOI: 10.1016/j.conctc.2024.101295
• Publication Date: 2024-04-13T02:25:48Z
• Authors: Tim R.E. Harris; Zain A. Bhutta; Isma Qureshi; Nadir Kharma; Tasleem Raza; Ali Ait Hssain; Ankush Suresh Pat...; Ashwin D'Silva; Mohamad Yahya Khatib; Mohamed Gafar Hus...; Ignacio Miguel Go...; Victor Ramon Garc...; Jorge Rosales Garcia; Stephen H. Thomas; Sameer A. Pathan
• Keywords: Medicine (General); 03 medical and health sciences; R5-920; 0302 clinical medicine; COVID-19; Emergency medicine; Awake prone positioning; Respiratory failure; Acute hypoxemia; General medicine, internal medicine and other clinical medicine; Article

Awake prone position (APP) has been reported to improve oxygenation in patients with COVID-19 disease and to reduce the requirement for invasive mechanical ventilation for patients requiring support with high flow nasal cannula. There is conflicting data for patients requiring lower-level oxygen support.Does APP reduce escalation of oxygen support in COVID-19 patients requiring supplementary oxygen?The primary outcome was defined as an escalation of oxygen support from simple supplementary oxygen (NP, HM, NRB) to NIV (CPAP or BiPAP), HFNC or IMV; OR from NIV (CPAP or BiPAP) or HFNC to IMV by day30.Two center, prospective, non-blind, randomised controlled trial. Patients with confirmed or suspected COVID-19 pneumonia requiring ≥ 5 liters/min oxygen to maintain saturations ≥ 94 % were randomised to either APP or control group. The APP group received a 3-h APP session three times per day for three days.Between 9 May and July 13, 2021, 89 adults were screened and 61 enrolled, 31 to awake prone position and 30 controls. There was no difference in the primary outcome, 7 (22.6 %) patients randomised to APP and 9 (30.0 %) controls required escalation of oxygen support (OR 0.68 (0.22-2.14), P = 0.51). There were no differences in any secondary outcomes, in APP did not improve oxygenation.In COVID-19 patients, the use of APP did not prevent escalation of oxygen support from supplementary to invasive or non-invasive ventilation or improve patient respiratory physiology.NCT04853979 (clinicaltrials.gov).