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Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial

Michael Fralick1, Michael Colacci2, Laveena Munshi3

  • 1Division of General Internal Medicine, Sinai Health, Toronto, ON, Canada mike.fralick@mail.utoronto.ca.

BMJ (Clinical Research Ed.)
|March 24, 2022
PubMed

Insights

Prone positioning did not improve outcomes for non-critically ill COVID-19 patients needing oxygen. Adherence was low, suggesting future trials should focus on improving patient positioning strategies.

Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Infectious Diseases

Background:

  • COVID-19 can cause hypoxemia requiring supplemental oxygen in non-critical patients.
  • Prone positioning is a known intervention to improve oxygenation in severe respiratory distress.

Purpose of the Study:

  • To evaluate the effectiveness of prone positioning in reducing death or respiratory failure in hospitalized COVID-19 patients.
  • To assess the impact of awake prone positioning on clinical outcomes in non-critically ill COVID-19 patients.

Main Methods:

  • A multicenter pragmatic randomized clinical trial involving 257 patients with COVID-19 requiring supplemental oxygen.
  • Patients were randomized to either receive instructions for prone positioning or standard care.
  • The primary outcome was a composite of in-hospital death, mechanical ventilation, or worsening respiratory failure.

Main Results:

  • The trial was stopped early due to futility.
  • No significant difference in the primary outcome was observed between the prone positioning group (14%) and the standard care group (14%).
  • Adherence to prone positioning was poor, with a median of 6 hours in the prone arm versus 0 hours in the control arm over 72 hours.

Conclusions:

  • A multifaceted intervention to increase prone positioning did not improve outcomes in non-critically ill COVID-19 patients with hypoxemia.
  • Wide confidence intervals mean benefit or harm cannot be definitively ruled out.
  • Future trials should focus on strategies to improve adherence to awake prone positioning.
Abstract

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