Awake Prone Positioning May Prevent Intubation in COVID-19

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by Healthday

Significant reduction seen in intubation with prone positioning for hospitalized patients with acute hypoxic respiratory failure

FRIDAY, Aug. 27, 2021 (HealthDay News) — For hospitalized patients with acute hypoxic respiratory failure due to COVID-19 who require respiratory support with a high-flow nasal cannula, awake prone positioning may reduce the need for intubation, according to a study published online Aug. 20 in The Lancet Respiratory Medicine.

Stephan Ehrmann, M.D., Ph.D., from CHRU Tours in France, and colleagues conducted a prospective collaborative meta-trial of six open-label superiority trials among adults who required respiratory support with a high-flow nasal cannula for acute hypoxemic respiratory failure due to COVID-19. A total of 1,126 patients at hospitals from six counties were randomly assigned to awake prone positioning or standard care (567 and 559, respectively); 1,121 were included in the intention-to-treat analysis.

The researchers found that treatment failure occurred in 40 and 46 percent of patients assigned to awake prone positioning and standard care, respectively (relative risk, 0.86; 95 percent confidence interval, 0.75 to 0.98). Compared with standard care, the hazard ratio with awake prone positioning was 0.75 (95 percent confidence interval, 0.62 to 0.91) for intubation and 0.87 (95 percent confidence interval, 0.68 to 1.11) for mortality. Both groups had a low incidence of prespecified adverse events.

“Our findings support the routine implementation of awake prone positioning in critically ill patients with COVID-19 requiring high flow nasal cannula oxygen therapy,” Ehrmann said in a statement. “It appears important that clinicians improve patient comfort during prone positioning, so the patient can stay in the position for at least eight hours a day.”

Several authors disclosed financial ties to the biopharmaceutical and medical device industry.

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