Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study
Gad, A., El-Bahnsawy, M., Abd El-Ghafar, M., Ibrahim, I., Hamed, A. (2025). Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study. EKB Journal Management System, 5(2), 18-33. doi: 10.21608/jicem.2025.427145
Alaa Mohamed Gad; Mohamed Gamal El-Bahnsawy; Mohamed Samir Abd El-Ghafar; Ibrahim Salah Eldin Ibrahim; Ahmed Mohammed Hamed. "Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study". EKB Journal Management System, 5, 2, 2025, 18-33. doi: 10.21608/jicem.2025.427145
Gad, A., El-Bahnsawy, M., Abd El-Ghafar, M., Ibrahim, I., Hamed, A. (2025). 'Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study', EKB Journal Management System, 5(2), pp. 18-33. doi: 10.21608/jicem.2025.427145
Gad, A., El-Bahnsawy, M., Abd El-Ghafar, M., Ibrahim, I., Hamed, A. Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study. EKB Journal Management System, 2025; 5(2): 18-33. doi: 10.21608/jicem.2025.427145

Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 5, Issue 2, June 2025, Pages 18-33    PDF (616.99 K)
Document Type: Original papers
DOI: 10.21608/jicem.2025.427145
Authors
Alaa Mohamed Gad* 1; Mohamed Gamal El-Bahnsawy2; Mohamed Samir Abd El-Ghafar3; Ibrahim Salah Eldin Ibrahim4; Ahmed Mohammed Hamed5
1Assistant Lecturer of Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
2Lecturer of Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
3Assistant Professor of Anesthesiology and Surgical Intensive Care Department, Faculty of Medicine, Tanta University, Tanta, Egypt
4Professor of Chest Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
5Professor of Anesthesiology and Surgical Intensive Care Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Abstract
Background: The COVID-19 pandemic has prompted the need for novel treatments for acute hypoxemic respiratory failure. Prone positioning, a method previously reserved for severe ARDS, is now being explored for its benefits in non-intubated COVID-19 patients to improve oxygenation and potentially decrease the reliance on mechanical ventilation and ICU care. Aim: To evaluate if prone positioning alongside standard treatment enhances outcomes in acute hypoxemic COVID-19 patients, focusing on ICU admission, mechanical ventilation rates, oxygenation, hospital stay, and 28-day mortality compared to standard treatment alone. Material and Methods: This prospective, randomized controlled study involved 90 COVID-19 patients, divided into Group P (proning plus standard care, n=45) and Group S (standard care alone, n=45) admitted to Tanta University Hospitals. The study assessed the impact of prone positioning on ICU admission rates, mechanical ventilation use, oxygenation improvement, hospital stay duration, and 28th-day mortality. Results: Improvements in PaO2/FiO2 and SpO2/FiO2 ratios were significantly better in Group P after 24 hours and at the endpoint (p values 0.031 and 0.014; 0.028 and 0.035, respectively). Inflammatory markers and lymphocyte counts improved significantly in Group P at the endpoint. No significant difference was observed in mechanical ventilation use, cardiac arrest, or 28-day mortality between the groups. The incidence of ICU admission was significantly lower in group P than group S (P value =0.038). Conclusions: Prone positioning could be an effective adjunct therapy in the management of moderate COVID-19-induced respiratory failure, potentially alleviating ICU resource strain.
Keywords
Prone Position; Acute Hypoxemia; COVID-19; Spontaneous Ventilation
References
 

  1. Villar J, Mora-Ordoñez JM, Soler JA, et al. The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era. Crit Care Explor. 2022;4:e0684. https://doi.org/10.1097/cce.0000000000000684
  2. Grasselli G, Greco M, Zanella A, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345-55. https://doi.org/10.1001/jamainternmed.2020.3539
  3. Foti G, Giannini A, Bottino N, et al. Management of critically ill patients with COVID-19: suggestions and instructions from the coordination of intensive care units of Lombardy. Minerva Anestesiol. 2020;86:1234-45. https://doi.org/10.23736/s0375-9393.20.14762-x
  4. Jiang B, Wei H. Oxygen therapy strategies and techniques to treat hypoxia in COVID-19 patients. Eur Rev Med Pharmacol Sci. 2020;24:10239-46. https://doi.org/10.26355/eurrev_202010_23248
  5. Pearson SD, Koyner JL, Patel BK. Management of Respiratory Failure: Ventilator Management 101 and Noninvasive Ventilation. Clin J Am Soc Nephrol. 2022;17:572-80. https://doi.org/10.2215/cjn.13091021
  6. Petrone P, Brathwaite CEM, Joseph DK. Prone ventilation as treatment of acute respiratory distress syndrome related to COVID-19. Eur J Trauma Emerg Surg. 2021;47:1017-22. https://doi.org/10.1007/s00068-020-01542-7
  7. Langer T, Brioni M, Guzzardella A, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care. 2021;25:128-31. https://doi.org/10.1186/s13054-021-03552-2
  8. Touchon F, Trigui Y, Prud'homme E, et al. Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives. Eur Respir Rev. 2021;30:1-8. https://doi.org/10.1183/16000617.0022-2021
  9. Fossali T, Pavlovsky B, Ottolina D, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with COVID-19 acute respiratory distress syndrome: A combined CT scan/electrical impedance tomography study. Crit Care Med. 2022;50:723-32. https://doi.org/10.1097/ccm.0000000000005450
  10. Hewitt J, McDonald S, Poole A, et al. Weekly updating of guideline recommendations was feasible: the Australian National COVID-19 clinical evidence Taskforce. J Clin Epidemiol. 2023;155:131-6. https://doi.org/https://doi.org/10.1016/j.jclinepi.2023.02.019
  11. Zayed NE, Abbas A, Lutfy SM. Criteria and potential predictors of severity in patients with COVID-19. Egypt J Bronchol. 2022;16:11-9. https://doi.org/10.1186/s43168-022-00116-y
  12. Wu S, Xue L, Legido-Quigley H, et al. Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital. Plos one. 2020;15:959-62.
  13. Thomas P, Baldwin C, Bissett B, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020;66:73-82.
  14. Bahloul M, Kharrat S, Hafdhi M, et al. Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing. Acute Crit Care. 2021;36:208-14. https://doi.org/10.4266/acc.2021.00500
  15. Nay MA, Hindre R, Perrin C, et al. Prone position versus usual care in hypoxemic COVID-19 patients in medical wards: a randomised controlled trial. Crit Care. 2023;27:240-55. https://doi.org/10.1186/s13054-023-04529-z
  16. Chiumello D, Chiodaroli E, Coppola S, et al. Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP. Ann Intensive Care. 2021;11:179-88. https://doi.org/10.1186/s13613-021-00967-6
  17. Sartini C, Tresoldi M, Scarpellini P, et al. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020;323:2338-40. https://doi.org/10.1001/jama.2020.7861
  18. Elharrar X, Trigui Y, Dols A-M, et al. Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA. 2020;323:2336-8.
  19. Jouffroy R, Darmon M, Isnard F, et al. Impact of prone position in non-intubated spontaneously breathing patients admitted to the ICU for severe acute respiratory failure due to COVID-19. J Crit Care. 2021;64:199-204. https://doi.org/10.1016/j.jcrc.2021.04.014
  20. Barker J, Pan D, Koeckerling D, et al. Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19. Postgrad Med J. 2022;98:360-4.
  21. Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, et al. Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study. Eur Respir J. 2022;59:3-10. https://doi.org/10.1183/13993003.00265-2021
  22. Wang Z, Feng Q, Yu H, et al. Clinical study of awake prone positioning treatment in patients with common coronavirus disease 2019 caused by Omicron variant. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022;34:576-80. https://doi.org/10.3760/cma.j.cn121430-20220418-00384
  23. Wormser J, Romanet C, Philippart F. Prone position in wards for spontaneous breathing Covid-19 patients: a retrospective study. Ir J Med Sci. 2021;190:1519-22. https://doi.org/10.1007/s11845-020-02479-x
  24. Rosén 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. Crit Care. 2021;25:209-13. https://doi.org/10.1186/s13054-021-03602-9
  25. Fralick M, Colacci M, Munshi L, et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ. 2022;376:2-10. https://doi.org/10.1136/bmj-2021-068585
  26. Peng Q, Yang S, Zhang Y, et al. Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023;10:5-15. https://doi.org/10.3389/fmed.2023.1120837
  27. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
  28. Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med. 2022:2-15.
  29. Alhazzani W, Parhar KKS, Weatherald J, et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure: a randomized clinical trial. JAMA. 2022;327:2104-13.
 

 

 

Statistics
Article View: 132
PDF Download: 56