Awake prone positioning in COVID-19: is tummy time ready for prime time?

Abstract

Prone positioning reduces mortality in moderate to severe acute respiratory distress syndrome requiring invasive mechanical ventilation. Before COVID-19, evidence supporting prone positioning for awake non-intubated patients with hypoxaemic respiratory failure was limited to small case series. Early in the COVID-19 pandemic, use of awake prone positioning (or so-called tummy time) to avoid intubation quickly gained traction in the media. Several observational studies reported that prone positioning improved oxygenation in awake non-intubated patients with COVID-19. Globally, many health-care jurisdictions adopted awake prone positioning for COVID-19, despite no high quality evidence from randomised controlled trials of improved clinically meaningful outcomes, including invasive mechanical ventilation or mortality. Of note, the Surviving Sepsis Campaign Guidelines highlighted this equipoise, stating that there was insufficient evidence to recommend awake prone positioning for COVID-19.

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https://creativecommons.org/licenses/by-nc-nd/4.0/

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Identifiers

DOI

https://doi.org/10.1016/S2213-2600(21)00368-4

Repository URI

https://www.research.ed.ac.uk/en/publications/be8cc9b0-49c7-4a15-bd2c-a2161f9a135b