Usually, it is done for critically ill patients who are sedated and intubated (breathing through a tube attached to a mechanical ventilator). But in February 2020, reports emerged that prone positioning of awake patients with COVID-19 may also benefit and it was widely adopted.
Since then, several studies have examined its effectiveness in awake patients with COVID-19, but the results have been conflicting.
To try and resolve this uncertainty, a team of Canadian and US researchers set out to assess the effectiveness of prone positioning to reduce the risk of death or respiratory failure in patients admitted to hospital with COVID-19.
Their findings are based on 248 awake patients with COVID-19 admitted to 15 hospitals in Canada and the US from May 2020 until May 2021. These patients were not critically ill but needed supplemental oxygen. Their average age was 56 years and 36% were female.
Patients were randomly assigned to either prone positioning or standard care (no instruction to adopt prone position). Patients in the prone arm were advised to adopt a prone position for up to two hours four times a day and encouraged to sleep in a prone position at night for up to seven days, with repeated efforts by staff to try to improve adherence.
The results show that discomfort was the main reason reported by patients for their low adherence to prone positioning.
After taking account of other potentially influential factors, the risk of death, mechanical ventilation, or worsening respiratory failure was similar between the prone group (18 events) and the standard care group (17 events).
The difference in the ratio of oxygen saturation to a fraction of inspired oxygen (an indication of how well the lungs are transferring oxygen to the blood) after 72 hours was also similar between the two groups.
The results of this well-designed trial that assessed both clinical and physiological outcomes, reflect the effectiveness of real-world interventions to encourage prone positioning in similar healthcare settings, explain the authors.
Future studies are needed to determine whether a greater amount of time spent in the prone position is associated with clinical benefit.
Source: Medindia
