Awake Prone Positioning in Patients With COVID-19 Respiratory Failure: A Randomized Clinical Trial.
Summary
In 445 non-intubated adults with COVID-19 hypoxemic respiratory failure, awake prone positioning for at least 6 hours/day had a 93.8% posterior probability of reducing the composite of intubation and/or death (mean OR 0.74). Secondary clinical benefits trended favorably but with overlapping credible intervals.
Key Findings
- Posterior probability of benefit for APP on intubation/death was 93.8% with a mean OR 0.74 (95% CrI 0.48–1.09).
- Trends toward more days alive outside ICU (+1.28 days) and outside hospital (+1.55 days), though CrIs included 0.
- Trial enrolled a mixed ward/ICU population and used intention-to-treat with a Bayesian framework.
Clinical Implications
Encourage structured awake prone positioning protocols targeting ≥6 hours/day for eligible hypoxemic COVID-19 patients, with monitoring for tolerance and adherence.
Why It Matters
Confirms a pragmatic, low-cost intervention that can be widely implemented in wards and ICUs, with robust Bayesian evidence across priors.
Limitations
- Open-label design and allowance for spontaneous prone positioning in controls may dilute effects.
- COVID-19 era heterogeneity (variants, co-interventions) could affect outcomes.
Future Directions
Define optimal daily duration, adherence strategies, and applicability to non-COVID hypoxemic pneumonia; assess patient-centered outcomes and safety in broader settings.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial providing high-level evidence of effectiveness.
- Study Design
- OTHER