Is Prone Positioning Beneficial in Non–Critically Ill COVID-19 Patients with Mild Hypoxemia?

Daily, prolonged prone positioning (12–18 hours) improves outcomes in critically ill adults with acute respiratory distress syndrome that requires mechanical ventilation. However, data on prone positioning in nonintubated hospitalized patients with COVID-19 is limited and conflicting. Researchers conducted a pragmatic, unblinded, randomized trial in 15 hospitals in the U.S. and Canada that involved 257 patients with COVID-19 who required supplemental oxygen (≤50% fraction of inspired oxygen [FiO₂]]). Patients were assigned to prone positioning (four 2-hour sessions daily, in addition to prone sleeping) or standard care (typical positioning).

Median daily times spent prone in the first 72 hours were ≈2.5 hours in the prone group and 0 hours in the typical-positioning group. No difference in the composite primary outcome — death, invasive mechanical ventilation, or worsening respiratory failure requiring ≥60% FiO₂ — was noted between the prone and standard groups (18% in each group).