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Updated: Jul 29, 2025

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure
Matthias Jacquet-Lagrèze1, Zakaria Riad2, Philippe Portran3
1Service d'anesthésie-réanimation, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France; Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France; and CarMeN Laboratory, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France. matthias.jacquet-lagreze@chu-lyon.fr.
Introduction:
Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure.
Methods:
We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session.
Results:
Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m2 in PP, 2.5 ± 0.6 L/min/m2 before PP (SP1), and 2.6 ± 0.5 L/min/m2 after PP (SP2, P < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 (P < .001). There was no significant difference in PaO /FIO and breathing frequency.
Conclusion:
CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.
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