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

## TL;DR

This study found that using the prone position while awake can reduce mortality in ICU patients with severe COVID-19.

## Contribution

The study demonstrates that awake prone positioning lowers mortality in severe COVID-19 patients without increasing intubation risk.

## Key findings

- Awake prone position was associated with a 13.9% mortality rate compared to 27.1% in the supine group.
- Awake prone position was the only variable significantly associated with lower mortality in the Cox regression model.
- Awake prone positioning did not significantly affect the rate of intubation or time on mechanical ventilation.

## Abstract

To investigate if awake prone position (PP) reduces the rate of endotracheal intubation and mortality in patients with COVID-19 admitted to the intensive care unit (ICU).

This was a retrospective cohort study of 726 patients who were admitted to the ICU with acute hypoxic respiratory failure secondary to COVID-19. The protocol of the institution recommended the use of awake PP in patients with nasal catheter with an oxygen flow ≥ 5 L/min and SpO2 ≤ 90% or a high-flow nasal catheter (HFNC) with FiO2 ≥ 50% and SpO2 ≤ 90%. The following data were collected: age, comorbidities, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, duration of invasive and noninvasive MV, HFNC therapy, nitric oxide therapy, hemodialysis and PP while spontaneously breathing.

There was a higher mortality rate in the supine position group (27.1%) than in the awake PP group (13.9%). There was no significant difference in the time on MV or number of patients on MV (p>0.05). The variables with p < 0.05 in the bivariate analysis were entered into the Cox regression model. The model was adjusted for awake PP, sex, age, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, chronic arterial disease, and noninvasive ventilation. The only variable associated with lower mortality over time was awake PP (hazard ratio: 0.55; 95% confidence interval: 0.33–0.92).

Awake prone position has been shown to be a safe and effective therapy that reduced mortality but not the risk of intubation in patients with COVID-19.