Awake Prone Positioning No Benefit for COVID-19-Linked Hypoxemia

Evidence shows worse clinical outcomes on day 5 for the intervention group versus the usual-care group

Awake Prone Positioning No Benefit for COVID-19-Linked Hypoxemia
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WEDNESDAY, April 20, 2022 (HealthDay News) -- For patients with COVID-19-associated hypoxemia who have not received mechanical ventilation, prone positioning is not associated with clinical benefit, according to a study published online April 18 in JAMA Internal Medicine.

Edward Tang Qian, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues conducted a pragmatic nonrandomized controlled trial involving 501 adults with COVID-19-associated hypoxemia who had not received mechanical ventilation. Patients were assigned to receive a practitioner-recommended awake prone positioning intervention or usual care.

Based on nursing observations, patients in the intervention and usual-care groups spent a median of 4.2 and 0 hours per day in the prone position. The researchers found that the Bayesian posterior probability of the intervention group having worse outcomes than the usual-care group on the modified World Health Organization ordinal outcome scale was 0.998 on day 5 (posterior median adjusted odds ratio [aOR], 1.63; 95 percent credibility interval [CrI], 1.16 to 2.31). However, the posterior probabilities of harm were 0.874 (aOR, 1.29; 95 percent CrI, 0.84 to 1.99) on day 14 and 0.673 (aOR, 1.12; 95 percent CrI, 0.67 to 1.86) on day 28. There was no difference observed between the groups in exploratory outcomes (progression to mechanical ventilation, length of stay, and 28-day mortality).

"These findings suggest that routine preferential use of prone positioning among patients with COVID-19 who require supplemental oxygen but are not receiving invasive mechanical ventilation may not be associated with patient benefits," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry; one disclosed owning a patent for risk stratification in sepsis and septic shock. The sensor work of several authors was supported by Smith & Nephew.

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