Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb 1;28(1):57-65.
doi: 10.1097/MCC.0000000000000900.

Prone position in COVID 19-associated acute respiratory failure

Aileen Kharat  1   2 , Marie Simon  3 , Claude Guérin  3   4   5
Affiliations
Review

Prone position in COVID 19-associated acute respiratory failure

Aileen Kharat et al. Curr Opin Crit Care. .

Abstract

Purpose of review: Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing ('awake prone'). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS.

Recent findings: A literature search retrieved 70 studies separating whether patient was intubated (24 studies) or nonintubated (46 studies). The outcomes analyzed were intubation rate, mortality and respiratory response to prone. In nonintubated patient receiving prone position, the main finding was mortality reduction in ICU and outside ICU setting.

Summary: The final results of the several randomized control trials completed or ongoing are needed to confirm the trend of these results. In intubated patients, observational studies showed that responders to prone in terms of oxygenation had a better survival than nonresponders.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Forrest plot for intubation at the latest recording time. CI, confidence interval; GLMM, general linear mixed model.
FIGURE 2
FIGURE 2
Forrest plot for mortality at the latest recording time. CI, confidence interval; GLMM, general linear mixed model.
FIGURE 3
FIGURE 3
Contoured-Funnel plots displaying the relationship between the effect of size on the x-axis and the standard error on the y-axis for intubation and mortality at the latest recording time. Grey, dark grey, and light grey contours pertain to less than 0.1, less than 0.05, and less than 0.01 levels of significance, respectively. The favorable effect of the experimental group, that is, the prone position, is shown in the left hand side of the funnel plots.
See this image and copyright information in PMC

References

    1. Covid-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021; 47:60–73. - PMC - PubMed

    2. A large prospective multicenter study in France describing the practice of mechanical ventilation in COVID-19 patients.

    1. Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, et al. COVID-19 Spanish ICU Network. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med 2020; 46:2200–2211. - PMC - PubMed

    2. A large prospective multicenter study in Spain on intubated patients with COVID-related ARDS describing mechanical ventilation settings, respiratory mechanics and outcome.

    1. Langer T, Brioni M, Guzzardella A, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multicentric study of more than 1000 patients. Crit Care 2021; 25:128. - PMC - PubMed

    2. A large multicenter study in Italy describing the practice of invasive mechanical ventilation in COVID ARDS. In addition, a subset of patients was analyzed based on their response to prone position. The mortality was lower in responders than in non responders.

    1. Guerin C, Beuret P, Constantin JM, et al. Investigators of the APRONET Study Group, the REVA Network, the Réseau recherche de la Société Française d’Anesthésie-Réanimation (SFAR-recherche) and the ESICM Trials Group. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med 2018; 44:22–37. - PubMed
    1. Bellani G, Laffey JG, Pham T, et al. LUNG SAFE Investigators, ESICM Trials Group. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315:788–800. - PubMed