Main Article Content
Objective: This article aims to review the current evidence in Covid-19 patients with acute respiratory failure who required awake prone positioning as a therapeutic intervention.
I searched the literature on MEDLINE, PubMed, Cochrane Library, Google Scholar, and other databases. I found several studies that analyzed and shared the data regarding awake prone positioning in the Covid-19 patients, with duration ranging from 12-16 hours.
I found that the major criteria used included PaO2/FiO2 ratio, SpO2/FiO2, respiratory rate, heart rate. I also searched the suggested indications, contra-indications, complications, and outcomes of those patients.
Awake proning showed improvement in lung mechanics and oxygenation, but no benefit in outcome in the majority of studies.
Currently, the data is unclear to determine the overall benefit. Further controlled trials are needed.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2. Abroug F, Ouanes-Besbes L, Dachraoui F, Ouanes I, Brochard L. An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury. Critical Care. 2011 Feb;15(1):1-9.
3. Sud S, Friedrich JO, Adhikari NK, Taccone P, Mancebo J, Polli F, Latini R, Pesenti A, Curley MA, Fernandez R, Chan MC. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Cmaj. 2014 Jul 8;186(10):E381-90.
4. Jump up to:a b c d e Guérin, Claude (2017), "Prone position", in Davide Chiumello (ed.), Acute Respiratory Distress Syndrome, Springer, pp. 73–84, ISBN 9783319418520
5. Davenport L. Top 10 must-dos in ICU in COVID-19 include prone ventilation. Medscape Medical News. 2020(March 21,).
6. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive care medicine. 2020 May;46(5):854-87.
7. Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet Respiratory Medicine. 2020 Aug 1;8(8):765-74.
8. Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review. World journal of critical care medicine. 2016 May 4;5(2):121.
9. Nyrén S, Radell P, Lindahl SG, Mure M, Petersson J, Larsson SA, Jacobsson H, Sánchez-Crespo A. Lung ventilation and perfusion in prone and supine postures with reference to anesthetized and mechanically ventilated healthy volunteers. The Journal of the American Society of Anesthesiologists. 2010 Mar 1;112(3):682-7.
10. Glenny RW, Robertson HT. Determinants of pulmonary blood flow distribution. Compr Physiol. 2011 Jan;1(1):39-59.
11. Kallet RH, Katz JA. Respiratory system mechanics in acute respiratory distress syndrome. Respir Care Clin N Am. 2003 Sep;9(3):297-319.
12. Froese AB. Gravity, the belly, and the diaphragm: you can't ignore physics. Anesthesiology. 2006 Jan;104(1):193-6.
13. Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province. Annals of intensive care. 2020 Dec;10(1):1-4.
14. Bower G, He H. Protocol for awake prone positioning in COVID-19 patients: to do it earlier, easier, and longer. Critical Care. 2020 Dec;24(1):1-3.
15. Stilma W, Åkerman E, Artigas A, Bentley A, Bos LD, Bosman TJ, De Bruin H, Brummaier T, Buiteman-Kruizinga LA, Carcò F, Chesney G. Awake proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: guidance from an international group of healthcare workers. The American Journal of Tropical Medicine and Hygiene. 2021 May;104(5):1676.
16. Costa LM, Nunes RA, Scudeler TL. Cardiopulmonary Resuscitation in Prone Position. International Journal of Cardiovascular Sciences. 2021 Feb 22;34:315-8.
17. Telias I, Katira BH, Brochard L. Is the prone position helpful during spontaneous breathing in patients with COVID-19?. Jama. 2020 Jun 9;323(22):2265-7.
18. Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Advances in Respiratory Medicine. 2021;89(1):1-7.
19. Dubosh NM, Wong ML, Grossestreuer AV, et al. Early, awake proning in emergency department patients with COVID-19. Am J Emerg Med. 2021;46:640-645. doi:10.1016/j.ajem.2020.11.074