26 Aug COVID-19: Awake Prone Positioning with Oxygen Therapy Reduced Treatment Failures

MedicalResearch.com Interview with:

Dr. Jie Li

Jie Li, PhD, RRT, RRT-ACCS, RRT-NPS, FAARC
Department of Cardiopulmonary Sciences
Division of Respiratory Care
Rush University, Chicago

MedicalResearch.com: What is the background for this study?

Response: Prone positioning has been shown to improve oxygenation and reduce mortality in intubated patients with acute respiratory distress syndrome (ARDS), as placing patients on their stomachs can help open alveoli and reduce ventilation to perfusion mismatch. At early pandemic, clinicians tried prone positioning for non-intubated patients with COVID-19 and found improvement in oxygenation. However, the evidence for patient outcomes such as intubation or mortality is still lacking. Thus we organized this international, multicenter, randomized controlled meta-trial, with 41 hospitals in 6 countries participated.

MedicalResearch.com: What are the main findings?

Response: We found awake prone positioning reduced the incidence of treatment failure within 28 days of enrollment, while the treatment failure was defined as intubation or death. Different from previous randomized controlled trials with small sample size, our patient population had acute severe hypoxemic respiratory failure due to COVID-19 and supported with high-flow nasal cannula oxygen therapy, with the mean SpO2/FiO2 ratio of 150.

We also found adverse effects were mild, no cardiac arrest associated with prone, infrequent and occurred at similar rates with patients assigned to awake prone positioning group and standard care group. 

MedicalResearch.com: What should readers take away from your report?

Response: Based on this study, for patients with COVID-19 induced acute hypoxemic respiratory failure who require high-flow nasal cannula oxygen therapy, awake prone positioning should be implemented as standard of care. and more importantly, we should make efforts to improve patients’ comfort under prone positioning, in order to help them stay at least 8 hours daily in awake prone positioning.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: In my opinion, future research should focus on four areas:

1) how to improve patient comfort under prone positioning, in order to improve their adherence to awake prone positioning;
2) the optimal timing to start prone positioning and identify the patients who will benefit most from awake prone positioning;
3) the optimal duration on prone positioning;
4) when to stop the awake prone positioning.

MedicalResearch.com: Is there anything else you would like to add? 

Response: Different from intubated patients underwent prone positioning, the duration of awake prone positioning is completely controlled by patients. as clinicians or researchers, we should attempt to improve patient comfort and adherence under prone position.

For disclosure, this study was supported by many sponsors, including Rice foundation, Open AI inc., Rice Foundation, Projet hospitalier de recherche clinique interrégional, appel d’offre 2020, Groupement Interrégional de Recherche Clinique et d’Innovation Grand Ouest (GIRCI GO), Association pour la promotion à Tours de la réanimation médicale, Fond de dotation du CHRU de Tours, Fisher & Paykel Healthcare Ltd.  The funders had no role in study design, data analysis, the preparation or approval of the manuscript, or the decision to submit the manuscript for publication.

Citation:

Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial

Ehrmann, StephanLi, Jie et al.
The Lancet Respiratory Medicine, Volume 0, Issue 0

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Last Updated on August 26, 2021 by Marie Benz MD FAAD