Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial.

Summary

In a multicenter RCT of 2143 analyzed adults undergoing sedation, lateral positioning significantly reduced hypoxemia compared with supine positioning and lowered the need for airway rescue interventions, without safety trade-offs. The benefits were observed across centers, supporting lateral positioning as a simple, scalable respiratory strategy during procedural sedation.

Key Findings

• Lateral positioning significantly reduced the incidence and severity of hypoxemia versus supine.
• Lateral position decreased the need for airway rescue interventions during sedation.
• No safety compromise was observed, supporting lateral positioning as a routine strategy.

Clinical Implications

Adopt lateral positioning as a default during procedural sedation to lower hypoxemia risk and reduce airway rescue interventions, especially in resource-constrained settings.

Limitations

• Generalizability to very high-risk subgroups (e.g., extreme obesity, very elderly) requires replication
• Blinding to positioning is not feasible, potentially introducing performance bias

Future Directions

Replicate in high-BMI and frail populations, and integrate with oxygen supplementation and airway adjunct protocols to define optimal bundles.