|Ehrmann et al (2021)
- Ehrmann S
- Li J
- Ibarra Estrada M
- et al.
Awake prone positioning for COVID-19 acute hypoxemic respiratory failure: a randomized, controlled, multinational, open-label meta-trial.
|United States, Mexico, Canada, Ireland, France and Spain
||Intensive care unit, intermediate care unit, emergency department and general services
||564 participants were given an awake prone position for as long and as frequently as possible; median daily duration 5 0 h (IQR 1 6–8 8) plus usual care
||557 participants received usual care (HFNC)
||Treatment failure within 28 days of enrollment, defined as intubation or death
||intubation; mortality; use of the NAV; length of hospital stay; time to HFNC withdrawal in patients who have succeeded in treatment; duration of IMV in intubated patients surviving to day 28; mortality in IMV patients; predefined security results; physiological response to awake prone positioning, including ROX index
|Taylor et al (2021)
- Taylor SP
- Bundy H
- Smith WM
- Skavroneck S
- Taylor B
- Kowalkowski MA
Awake-prone positioning strategy for non-intubated hypoxic patients with COVID-19: a pilot trial with integrated implementation evaluation.
||27 participants received an awake prone position plus usual care
||13 received usual care (room air, nasal cannula, HFNC or NIV)
||Results relating to the successful implementation of a future definitive RCT
||Until discharge or death
||S/F; time on S/F 6 L/min; intubation; length of hospital stay; hospital mortality at 48 hours; safety results
|Johnson et al (2021)
- Johnson SA
- Hortons DJ
- More complete MJ
- et al.
Patient-directed prone positioning in awake COVID-19 patients requiring hospitalization (PAPR).
||15 participants received awake prone positioning every 4 h, lasting 1–2 h or as long as tolerated; median total duration 1 6 h (IQR 0 2–3 1) plus usual care
||15 participants received usual care (room air or nasal cannula)
||Change of P/F at 72 h after admission
||The change of P/F at 48 h; the need for endotracheal intubation; transfer to intensive care; escalation in the oxygen delivery system; the duration of the stay; duration of stay ; ventilator-free days; hospital mortality
|Rosen et al (2021)
- Rosen J.
- von Oelreich E
- Fors D
- et al.
Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial.
||USI and general room
||36 participants received an awake prone position for at least 16 h/day; median daily duration 9 0 h (IQR 4 4–10 6) plus usual care
||39 participants received usual care (HFNC or NIV)
||Intubation within 30 days of enrollment
||Duration of awake prone positioning; use of the NAV; NIV delay for patients included with HFNC; use of vasopressors or inotropes; CRRT; ECMO; ventilator-free days; days without VIN or HFNC; length of stay in hospital and intensive care; 30-day mortality; WHO ordinal scale for clinical improvement at 7 and 30 days; adverse events
|Kharat et al (2021)
- Kharat A
- Dupuis-Lozeron E
- Singer C
- et al.
Self-pronation in COVID-19 patients on low-flow oxygen therapy: a cluster-randomised controlled trial.
||10 participants received an awake prone position, self-pronation for 12 h/day, and alternate body position every 4 h; median total duration 4 9 h (SD 3 6) plus usual care
||17 participants received usual care (nasal cannula)
||Oxygen requirements assessed by nasal cannula oxygen flow at 24 h
||S/F ratio at 24 h; 24-hour respiratory and heart rate; patient trajectory (transfer to intensive care unit) and potential adverse effects related to the procedure as defined by neck pain; positional discomfort and gastroesophageal reflux; intubation; dead at 28 days
|Jayakumar et al (2021)
- Jayakumar D
- Ramachandran Dnb P
- Rabindrarajan Dnb E
- Vijayaraghavan MD BKT
- Ramakrishnan Ab N
- Venkataraman Ab R
Standard care versus awake prone position in non-intubated adult patients with acute hypoxemic respiratory failure secondary to COVID-19 infection – a multicenter feasibility randomized controlled trial.
||30 participants received awake prone positioning for at least 6 h/day plus usual care
||30 participants received usual care (nasal cannula, face mask, mask without rebreather, HFNC or NIV)
||The proportion of patients adhering to the protocol
||Until discharge or death
||Proportion of patients requiring increased respiratory support; number of hours lying down and maximum hours of continuous prone positioning in a day; length of stay in intensive care; ICU mortality; adverse events
|Gad et al (2021)
Awake prone positioning versus noninvasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure.
||15 participants received awake prone positioning for 1-2 h each session 3 h apart during waking hours for the first 3 days plus usual care
||15 participants received usual care (mask without rebreather)
||Improvement of oxygenation and avoidance of intubation in the first 3 days after admission to intensive care
||Stay in intensive care and stay in hospital
|Fralick et al (2021)
- Fralick M
- Colacci M
- Munshi L
- et al.
Prone Positioning of Patients with Moderate Hypoxia Due to COVID-19: A Multicenter Pragmatic Randomized Trial [COVID PRONE].
|Canada, United States
||126 participants received an awake prone position four times a day (up to 2 h for each session) and they were encouraged to sleep in the prone position at night; median total duration 6 h (IQR 1 5–12 8) in the first 72 h and 0 h (IQR 0–12) from 72 h to 7 days; plus usual care
||122 participants received usual care (nasal prong, venturi mask, HFNC)
||A composite of in-hospital death, mechanical ventilation, or worsening respiratory failure defined as requiring at least 60% fractional inspired oxygen for more than 24 h
||Components of the composite analyzed individually; time spent lying down; change of S/F; recovery time (defined as being in room air for at least 24 h); time to discharge from hospital; and the rate of serious adverse events
|Garcia et al (2021)
- Garcia MA
- Rampon GL
- Doros G
- et al.
Rationale and design of the awake prone position for early hypoxemia in the COVID-19 study protocol (APPEX-19).
||159 participants received awake prone positioning in up to four daily 1–2 h sessions, and up to 12 h at night plus usual care
||134 participants received usual care (room air, nasal cannula, mask or HFNC)
||Progression of acute respiratory failure, composite outcome of either respiratory deterioration (i.e., progression to mask without rebreather, HFNC, NIV, IMV, or requiring oxygen boost ≥ 2 L/min compared to their initial value) or admission to the ICU
||14 days (or until discharge or death)
||Respiratory deterioration; admission to ICU; receipt of IMV; hospital mortality; diagnosis of ARDS; self-reported median dyspnea (Borg score); safety results; and respect for the awake positioning on the stomach
|Harris et al (NCT04853979)
||31 participants received awake prone positioning for at least 3 h/day and up to 16 h/day plus usual care
||30 participants received usual care (nasal cannula, mask without rebreather, HFNC or NIV)
||Escalation of respiratory support within 30 days of study
||Incidence of intubation within 30 days of enrollment; use of nasal prongs, Hudson mask, mask without rebreather, NIV and IMV in each group during the first 3 days of the study; physiological response to the mean supine position on days 1-3; P/F or S/F ratio and ROX index at baseline, 1 hour after the first prone position and daily for 4 days; tilt tolerance time; 28-day mortality; length of stay in intensive care unit and hospital; duration of IMV; moving devices; adverse events