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Use of prone position in spontaneous breathing in patients with COVID-19

Rodrigo Cerqueira Borges1, Isadora Salvador Rocco2, Camila Botana Alves Ferreira1

  • 1Hospital Samaritano Higienópolis, São Paulo, Brazil.

Journal of Critical Care Medicine (Universitatea De Medicina Si Farmacie Din Targu-Mures)
|May 19, 2025
PubMed

Insights

Awake prone positioning (PP) in COVID-19 patients reduced mortality in the ICU but did not significantly lower intubation rates. This safe and effective therapy offers a promising approach for managing severe respiratory failure.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • COVID-19 associated acute hypoxic respiratory failure frequently requires intensive care unit (ICU) admission.
  • Management strategies aim to reduce mortality and the need for mechanical ventilation.
  • Prone positioning (PP) is a recognized intervention for improving oxygenation in respiratory distress.

Purpose of the Study:

  • To evaluate the impact of awake prone positioning (PP) on endotracheal intubation rates and mortality in ICU patients with COVID-19.
  • To assess the safety and efficacy of awake PP as a therapeutic intervention.

Main Methods:

  • Retrospective cohort study involving 726 ICU patients with COVID-19 and acute hypoxic respiratory failure.
  • Patients received awake PP according to institutional protocol, often in conjunction with high-flow nasal catheter (HFNC) therapy.
  • Data collected included demographics, comorbidities, disease severity scores, and respiratory support parameters.

Main Results:

  • Awake prone position (PP) was associated with a significantly lower mortality rate (13.9%) compared to the supine position (27.1%).
  • No significant difference was observed in the duration or incidence of mechanical ventilation between the groups.
  • Cox regression analysis identified awake PP as the sole variable significantly associated with reduced mortality (hazard ratio: 0.55; 95% CI: 0.33-0.92).

Conclusions:

  • Awake prone positioning (PP) is a safe and effective intervention for critically ill COVID-19 patients.
  • PP significantly reduces mortality in this patient population.
  • Awake PP does not appear to decrease the need for endotracheal intubation in patients with COVID-19.
Abstract

Keywords:
COVID-19ICUprone position

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