Awake Prone Positioning Improves Survival and Reduces Intubation in COVID-19 Patients: JAMA
Researchers have found in a new study that awake prone positioning (APP) improves substantially survival without intubation and decreases mortality in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF). APP, a non-invasive strategy in which patients are placed face down while awake, has been extensively applied during the pandemic, but its capacity to enhance clinical outcomes was uncertain. The study was conducted by Jian L. and colleagues published in the journal of JAMA Internal Medicine.
The meta-analysis included evidence up to August 1, 2024, from PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov. The analysis included data from 3019 adult patients with COVID-19 and AHRF, 1542 of whom were in the APP group (mean age 59.3 years, 68.0% male) and 1477 in the control group (mean age 59.9 years, 66.3% male). The main outcome was survival without intubation, and secondary outcomes were intubation rate, hospital mortality, admission to the ICU, and invasive mechanical ventilation duration. For binary outcomes, logistic regression was employed, and for continuous outcomes, linear regression was employed.
Key Findings
Survival Without Intubation: APP made survival without intubation more likely (OR 1.42, 95% CI: 1.20-1.68).
Intubation Rates: APP patients had a reduced risk of intubation (OR 0.70, 95% CI: 0.59-0.84).
Hospital Mortality: APP decreased the risk of hospital mortality (OR 0.77, 95% CI: 0.63-0.95).
Time to Intubation: APP lengthened the time from enrollment to intubation by 0.93 days on average (95% CI: 0.43 to 1.42 days).
App Duration Impact: APP for 10 or more hours a day on the first three days was associated with improved survival without intubation (OR 1.85, 95% CI: 1.37-2.49).
Subgroup Analyses: Improved survival in patients below the age of 68 years, patients with BMI 26-30, early APP use (within one day of hospitalization), and with moderate respiratory distress (respiratory rate 20-26 breaths/min).
The study authors confirm that awake prone positioning greatly enhances clinical outcomes among patients with COVID-19 and AHRF. By lowering intubation rates, prolonging the period before mechanical ventilation, and decreasing hospital mortality, APP is a low-cost effective intervention that needs to be included in standard care.
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