Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded...

Area of Science:

• Critical Care Medicine
• Pulmonology
• Implementation Science

Background:

• Prone positioning is a potential therapy for hypoxemic, non-intubated COVID-19 patients.
• Its effectiveness requires validation through randomized controlled trials.

Purpose of the Study:

• To identify factors influencing the successful execution of a definitive clinical trial on awake prone positioning strategy (APPS) for non-intubated COVID-19 patients.
• To assess the feasibility and barriers of implementing APPS in a hospital setting.

Main Methods:

• A cluster randomized pilot trial comparing usual care (UC) with APPS plus UC.
• Included patients had COVID-19 related hypoxia (SpO2 <93% or new O2 requirement).
• Mixed-methods approach including oxygenation measures (S/F ratio) and qualitative interviews.

Main Results:

• The APPS group showed a trend towards better oxygenation (higher median S/F ratio) compared to UC.
• Patients in the APPS group spent less time with low S/F ratios.
• Barriers identified include low adherence to prone positioning and discrepancies in tolerated durations.

Conclusions:

• A definitive trial for APPS in non-intubated COVID-19 patients is necessary.
• Addressing implementation barriers is crucial for trial success and clinical translation.