Proning Nonintubated COVID-19 Patients with Acute Respiratory Distress Syndrome

Prone positioning is used to treat mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Numerous studies have demonstrated improved oxygenation in the prone position, and mortality benefit was shown in a large randomized, controlled trial (NEJM JW Gen Med Jul 15 2013 and N Engl J Med 2013; 368:2159). As the COVID-19 pandemic spread, clinicians became concerned about a potential shortage of ventilators. Many recommended that patients spend time in the prone position in an attempt to avoid or delay intubation. In two brief reports, authors describe single-center experiences with this intervention.

In the first study, investigators in France attempted prone positioning (for as long as tolerated) i…