Prone positioning for COVID-19 patients

AHS’ COVID-19 Scientific Advisory Group (SAG) recently investigated the latest evidence from around the world pertaining to a key topic: prone positioning for COVID-19 patients.

Prone positioning is a non-pharmacological therapy for hypoxemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS) where patients lay on their stomach rather than their back; it can be a life-saving intervention for intubated and mechanically ventilated patients in the ICU. While prone positioning may improve oxygen saturation levels for COVID-19 patients with acute HRF, its effect on clinical outcomes and associated risks have not been established. Although it may improve oxygen saturation there is less data on impact on overall outcome measures, and previous studies in patients with ARDS raise concerns about aspiration, hemodynamic instability, pressure ulcers, cardiac arrest, and delayed intubation.

Recommendations & Practical Considerations

Prone positioning of awake COVID-19 patients with HRF is not recommended in routine practice due to the lack of evidence pertaining to efficacy and risk to patients.

If a patient is being considered for awake prone positioning outside of clinical trials:

• They should be assessed to determine their ability to communicate; contraindications related to prone positioning, like respiratory distress, should be ruled out.
• Health system equipment, staffing and monitoring should be assessed to ensure patient safety.
• For non-critical care COVID-19 patients, a pathway should be developed to determine thresholds of care related to escalation and/or discontinuation of the intervention.

To see the complete list of Rapid Response Reports, please check the COVID-19 Scientific Advisory Group website. New reports and updates appear here on a daily basis.