No Benefit to Awake Self-Proning for Patients with COVID-19

Proning is a standard part of care for patients with moderate-to-severe acute respiratory distress syndrome because it lowers mortality. Extrapolating from results in critically ill patients, clinicians began to recommend awake self-proning for hypoxemic patients with COVID-19 to try to avoid mechanical ventilation. Case series and small trials of self-proning in COVID-19 patients have demonstrated improved oxygenation and have suggested that intubation might be avoided (e.g., NEJM JW Gen Med Aug 1 2020 and JAMA Intern Med 2020; 180:1537).

International investigators randomized 400 patients with COVID-19 who were supported by at least 40% oxygen (but not intubated) to either awake prone positioning with a goal of 8 to 10 hours daily or usual…