Prone position might not work for awake COVID-19 patients

Proning—lying on the stomach—has been useful for treating intubated, sedated COVID-19 patients, but a new study designed to tease out possible benefits for awake patients found that the method is difficult to use.Early in the pandemic, when there were few treatments for COVID-19 and hospital wards were overwhelmed, doctors reported benefits in severely ill patients who were placed in the prone position, a well-known strategy for managing patients who are in acute respiratory distress.It wasn't clear, however, if proning, which is designed to allow more oxygen into the lungs, would be useful for those with less severe infections, who typically are awake and receiving oxygen.No differences in clinical, physiologic outcomesTo assess the treatment in less severe hospitalized patients, researchers from Canada and the United States conducted a randomized trial that looked at both clinical and physiological outcomes.

They published their findings yesterday in BMJ.They based their findings on 248 awake patients who were admitted for COVID-19 at 15 Canadian and US hospitals from May 2020 to May 2021.

Patients were randomly assigned to either prone positioning with the goal of 2 hours four times during the day plus sleeping prone at night for a week, if possible, or standard treatment.For the prone group, hospital staff were encouraged to support adherence to the suggested proning schedule.

About 4% of the patients were on high-flow oxygen at baseline.The researchers found that, over the first 3 days, the proning group averaged only about 2.5 hours per day in the position, with discomfort the main reason for low adherence.Clinical course didn't vary between the two groups.