Awake prone positioning may prevent intubation in patients with COVID-19
Awake prone positioning early after hospital admission significantly reduced the need for mechanical ventilation among patients with hypoxemic respiratory failure due to COVID-19, researchers reported.
“Our findings support the routine implementation of awake prone positioning in critically ill patients with COVID19 requiring high flow nasal cannula oxygen therapy,” Stephan Ehrmann, MD, PhD, professor of critical care medicine at Tours University Hospital and researcher at the Research Center for Respiratory Disease at the National Institute of Health and Biomedical Research at Tours University, France, said in a related press release. “It appears important that clinicians improve patient comfort during prone positioning, so the patient can stay in the position for at least 8 hours a day.”
The researchers conducted a prospective metal-trial of six randomized, controlled, open-label superiority trials that involved 1,126 adults with COVID-19 hypoxemic respiratory failure requiring respiratory support with high-flow nasal cannula from April 2020 to January 2021. Patients at hospitals in Canada, France, Ireland, Mexico, Spain and the United States were randomly assigned to awake prone positioning (n = 567) or standard care (n = 559).
“Breathing in the prone position helps the lungs work more efficiently. When people with severe oxygenation issues are laying on their stomachs, it results in better matching of the blood flow and ventilation in the lungs, which improves blood oxygen levels,” Jie Li, PhD, associate professor and respiratory therapist at Rush University Medical Center, said in the release.
The primary outcome was treatment failure, which researchers defined as the number of patients who were intubated or died within 28 days.
Investigators included all but five patients in the intention-to-treat analysis (n = 1,121).
Treatment failure occurred in 40% of 564 patients assigned to awake prone positing compared with 46% of 557 patients assigned to standard care (RR = 0.86; 95% CI, 0.75-0.98; P = .02).
At 28 days, the cumulative incidence of intubation was lower among patients assigned to awake prone positioning compared with patients assigned standard care (HR = 0.75; 95% CI, 0.62-0.91; P = .0038). In addition, mortality at 28 days was similar between groups, even among patients who received invasive mechanical ventilation (HR = 0.87; 95% CI, 0.68-1.11; P = .27).
Incidence of adverse events such as skin breakdown (1% vs. 2%), vomiting (3% vs. 3%) and central or arterial line dislodgement (5% vs. 3%) were similar among both groups.