Original Research

Efficacy of awake prone position to avoid mechanical ventilation for patients with COVID-19

Leonardo Cordeiro de Souza, Daniel de Almeida Thiengo, Fernando da Franca Bastos de Oliveira, Clovis Jean Cruz Faria, Marcos David P. Godoy, Arthur Evangelista da Silva Neto, André Luiz da C. Serejo, Raphaela Cristinne Carvalho Cordeiro, Amarildo Abreu, Victor Ricardo S. Daher

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Background: During the COVID-19 pandemic the application of awake prone position (PP) in subjects has been describing such as a new procedures in combating the acute hypoxemic. Aim: Evaluate the efficacy of the awake PP in patients with hypoxemic respiratory failure by COVID-19 to avoid mechanical ventilation (MV). Methods: a clinical study. The subjects who were showing signs of hypoxemic respiratory failure were divided into two groups: the intervention group receiving treatment with oxygen therapy plus awake PP, and the control group only oxygen therapy. The primary outcome was the success to avoid the MV, and secondary outcomes were complications, length of stay and mortality rate in the ICU. Results: Thirty-two subjects underwent the PP in the Intervention group, and 35 maintained the conventional treatment with the oxygen therapy in the control group. The mean of the clinical variables analyzed did not show difference when comparing the groups. The rate of need of invasive mechanical ventilation (60% vs. 41%, P=0.18) and death rate (29% vs. 13%, P=0.29) was higher in the control group; however statistical diferences not were found. In the Kaplan-Meyer curves, the awake PP presented a tendency of reduction in mortality rate (15%), P=0.29 and presented a tendency of increase (30%) successful to avoid MV, P=0.16. Conclusion: The present study despite demonstrating that a simple procedure seems to contribute with a success rate to avoid the mechanical ventilator, however we cannot affir


Mechanical ventilation; Critical care; Respiratory Insufficiency; Prone Position; COVID-19.


1. Arabi YM, Fowler R, Hayden FG. Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Med. 2020;46(2):315-28. http:// PMid:32040667.

2. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68. http://dx.doi. org/10.1056/NEJMoa1214103. PMid:23688302.

3. Scaravilli V, Grasselli G, Castagna L, Zanella A, Isgrò S, Lucchini A, et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated subjects with hypoxemic acute respiratory failure: a retrospective study. J Crit Care. 2015;30(6):1390-4. jcrc.2015.07.008. PMid:26271685.

4. WHO: World Health Organization [Internet]. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. [cited 2020 Mar 13]. Available from: doi/full/10.1056/NEJMoa1214103.

5. Pan L, Wang L, Huang X. How to face the novel coronavirus infection during the 2019-2020 epidemic: The experience of Sichuan Provincial People’s Hospital. Intensive Care Med. 2020;46(4):573-5. 05964-0. PMid:32072300.

6. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatment for diferente phenotypes? Intensive Care Med. 2020;46(6):1099-102. 06033-2. PMid:32291463.

7. Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, non-intubated subjects in the emergency department: a single ED’s experience during the COVID-19 Pandemic. Acad Emerg Med Published. 2020;27(5):375-378. https://

8. Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Suppl. 4):S280-8. http://dx.doi. org/10.1513/AnnalsATS.201704-343OT. PMid:29068269.

9. Valter C, Christensen M, Tollund C, Schønemann NK. Response to the prone position in spontaneously breathing subjects with hypoxemic respiratory failure. Acta Anaesthesiol Scand. 2003;47(4):416-8. http://dx.doi. org/10.1034/j.1399-6576.2003.00088.x. PMid:12694139.

10. Feltracco P, Serra E, Barbieri S, Milevoj M, Michieletto E, Carollo C,  et  al. Noninvasive high-frequency percussive ventilator in the prone position after lung transplantation. Transplant Proc. 2012;44(7):2016-21. http://dx.doi. org/10.1016/j.transproceed.2012.05.062. PMid:22974896.

11. Feltracco P, Serra E, Barbieri S, Persona P, Rea F, Loy M, et al. Non-invasive ventilator in prone position for refractory hypoxemia after bilateral lung transplantation. Clin Transplant. 2009;23(5):748-50. j.1399-0012.2009.01050.x. PMid:19637990.

12. Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Crit Care. 2020;24(28):28. 2738-5. PMid:32000806.

13. Dong W, Gong Y, Feng J, Bai L, Qing H, Zhou P, et al. Early Awake prone and lateral position in non-intubated severe and critical subjects with COVID-19 in Wuhan: A respective cohort study. Scientifc Reports. 2020;11:1-16.https://doi.or g/10.1101/2020.05.09.20091454.

14. Elharrar X, Trigui Y, Dols AM, Touchon F, Martinez S, Prud’homme E,  et  al. Use of prone positioning in nonintubated subjects With COVID-19 and Hypoxemic Acute Respiratory Failure. JAMA. 2020;323(22):2336-8. http:// PMid:32412581.

15. Ding L, Wang L, Ma W, He H, Wenzhong L, Hualan L. Efficacy COVID-19: Attacks the 1-Beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism. ChemRxiv. 2020. chemrxiv.11938173.v6.

16. Liang W, Liang H, Ou L, Chen B, Chen A, Li C,  et  al. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized subjects with COVID-19. JAMA Intern Med. 2020;180(8):1081-9. PMid:32396163.

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