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

Summary

In a multicenter RCT of 2,143 sedated adults, lateral positioning significantly reduced hypoxemia compared with supine (5.4% in the lateral group), lowered severity, and reduced airway rescue interventions without compromising safety.

Key Findings

• Primary outcome: hypoxemia incidence was significantly lower with lateral positioning; 5.4% (58/1073) in the lateral group versus higher in supine (significant difference).
• Lateral positioning reduced the severity of desaturation and the need for airway rescue interventions.
• No safety compromise was observed; the strategy is low-cost and easily implementable.

Clinical Implications

Adopt lateral positioning during procedural sedation to reduce hypoxemia and airway rescue needs, especially in resource-limited settings where monitoring and rescue capacity may be constrained.

Limitations

• Blinding to body position is not feasible and may introduce performance bias
• Generalizability to very elderly or high-BMI populations needs confirmation as noted by authors

Future Directions

Assess effectiveness in high-risk populations (advanced age, obesity, OSA) and evaluate integration with oxygen delivery strategies and capnography in diverse settings.