Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Prone position is difficult to maintain and may be ineffective in non-ICU patients with COVID-19
Clinical Question
In ward patients with COVID-19 who require oxygen but not mechanical ventilation, is recommending a prone position effective in decreasing worsening disease or preventing death?
Bottom line
Given the option, noncritically ill patients are not prone to staying in a prone position if they can avoid it. In this study of non–intensive care patients, patients were unable to stay in the prone position for the recommended time (they averaged just 6 hours over 3 days). As a result, the researchers were unable to demonstrate a difference, if one exists, between supine and prone positions in these patients. The study was likely too small and adherence to "proning" was too low to find a difference if one truly exists. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Inpatient (ward only)
Synopsis
These investigators enrolled 257 patients in 15 hospitals in the United States and Canada with a laboratory-confirmed or clinically highly suspected diagnosis of COVID-19. The patients required supplemental oxygen (up to 50% inspired air) but were treated in a ward (ie, not in an intensive care unit). Patients were randomized, unmasked but with concealed allocation, to receive usual care or usual care with the recommendation to adopt a prone position 4 times a day for up to 2 hours at a time and to sleep in the prone position. The patients were all capable of moving themselves. The average patient spent just 6 hours on their stomachs over the first 3 days. The primary outcome — a composite of in-hospital death; need for mechanical ventilation; and worsening respiratory failure, defined as needing at least 60% fraction of inspired oxygen for at least 24 hours — was not different between the 2 groups (14% in each group). The low adherence to adopting the prone position may be the reason a difference wasn't found, and there may be a benefit if better ways could be found to improve the tolerability of the position.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Prone Position in Covid-19
Self evident that that the prone position could / would not be tolerated by patients.
How so
How so
Proning in Covid-19
"...simply instructing patients to lie prone and providing them with reminders is insufficient for most patients to spend a prolonged period in the prone position... innovative, more directive strategies may be needed to encourage awake patients to adopt a prone position for more than a few hours each day."
prone in icu covid 19
sensable
prone position in noncritical covid
prone position may not be more effective