Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study

Efeito da aplicação do posicionamento prono acordado precoce no prognóstico em pacientes com insuficiência respiratória aguda por pneumonia por COVID-19: um estudo observacional retrospectivo

Mustafa Altinay; Ismet Sayan; Hacer Sebnem Turk; Ayse Surhan Cinar; Pınar Sayın; Tugba Yucel; Serkan Islamoglu; Melis Turkel Ozkan; Ilay Cetiner

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We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia.

This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO2, PaO2, pH, SpO2 values and PaO2/FiO2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded.

The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO2 value of the APP group was 95%, the median PaO2 value was 82 mmHg, whereas the SpO2 value of the non-APP group was 90% and the PaO2 value was 66 mmHg. (p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group (p = 0.020, p = 0.001)

Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.


COVID-19;  Respiratory failure;  Prone position;  Intensive Care Unit


Justificativa: Avaliamos o efeito da administração precoce da posição prona acordada nos requisitos de oxigenação e intubação e na mortalidade a curto prazo em pacientes com insuficiência respiratória aguda devido à pneumonia por doença de coronavírus 2019 (COVID-19). Métodos: Trata-se de um estudo observacional de coorte. Foram incluídos pacientes que receberam oxigenoterapia com máscara em nossas unidades de terapia intensiva por insuficiência respiratória aguda devido à pneumonia por COVID-19. O grupo Posicionamento Prono Acordado (PPA) consistiu em pacientes que foram aplicados na posição prona acordada, enquanto o grupo não PPA consistiu em pacientes que não foram aplicados na posição prona acordada. Os valores de PaCO2, PaO2, pH, SpO2 e relações PaO2/FiO2 foram registrados no início e na 24ª hora. Dados demográficos, comorbidades, necessidade de intubação, dias sem ventilador, tempo de permanência na unidade de terapia intensiva e mortalidade a curto prazo dos pacientes foram registrados. Resultados: Os dados de um total de 225 pacientes foram examinados e 48 pacientes que preencheram os critérios do nosso estudo foram incluídos. Na 24ª hora, o valor mediano de SpO2 do grupo APP foi de 95%, o valor mediano de PaO2 foi de 82 mmHg, enquanto o valor de SpO2 do grupo não APP foi de 90% e o valor de PaO2 foi de 66 mmHg. (p = 0,001, p = 0,002). Não houve diferença estatisticamente significativa entre os grupos no tempo de permanência na unidade de terapia intensiva e dias sem ventilação, mas a mortalidade a curto prazo e as necessidades de intubação foram menores no grupo APP (p = 0,020, p = 0,001) Conclusão: A aplicação da posição prona em pacientes que recebem oxigenoterapia com máscara sem reinalação para insuficiência respiratória por pneumonia por COVID-19 melhora a oxigenação e diminui os requisitos de intubação e a mortalidade.


COVID-19; Parada respiratória; Posição prona; Unidade de Tratamento Intensivo


1 N. Chen, M. Zhou, X Dong, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Lancet., 395 (2020), pp. 507-513

2 C. Guérin, J. Reignier, J.-C. Richard, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome N Engl J Med., 368 (2013), pp. 2159-2168

3 RH Kallet A comprehensive review of prone position in ARDS Respir Care., 60 (2015), pp. 1660-1687

4 L. Munshi, L. Del Sorbo, N.K.J. Adhikari, et al. Prone position for acute respiratory distress syndrome: A systematic review and meta-analysis Ann Am Thorac Soc., 14 (2017), pp. S280-8

5 L. Ding, L. Wang, W. Ma, et al. 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., 24 (2020), pp. 1-8

6 Q. Sun, H. Qiu, M. Huang, et al. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province Ann Intensive Care., 10 (2020), pp. 2-5

7 N.D. Caputo, R.J. Strayer, R. Levitan Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED’s Experience During the COVID-19 Pandemic Acad Emerg Med., 27 (2020), pp. 375-378

8 P. Ghelichkhani, M. Esmaeili Prone Position in Management of COVID-19 Patients; a Commentary Arch Acad Emerg Med., 8 (2020), pp. 1-3

9 Z Wu, JM McGoogan Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China JAMA., 323 (2020), p. 1239

10 X. Yang, Y. Yu, J. Xu, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study Lancet Respir Med., 8 (2020), pp. 475-481

11 L. Gattinoni, D. Chiumello, S. Rossi COVID-19 pneumonia: ARDS or not? Crit Care., 24 (2020), pp. 1-3

12 L. Gattinoni, D. Chiumello, P. Caironi, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med., 46 (2020), pp. 1099-1102

13 W. Alhazzani, M.H. Møller, Y.M. Arabi, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19) Intensive Care Med., 46 (2020), pp. 854-887

14 C. Guérin, P. Beuret, J.M. Constantin, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study Intensive Care Med., 44 (2018), pp. 22-37

15 J McCormick, B Blackwood Nursing the ARDS patient in the prone position: The experience of qualified ICU nurses Intensive Crit Care Nurs., 17 (2001), pp. 331-340

16 W. Guan, Z. Ni, Y. Hu, et al. Clinical Characteristics of Coronavirus Disease 2019 in China N Engl J Med., 382 (2020), pp. 1708-1720

17 E. Livingston, K. Bucher Coronavirus Disease 2019 (COVID-19) in Italy JAMA., 323 (2020), p. 1335

18 G. Onder, G. Rezza, S. Brusaferro Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy JAMA., 323 (2020), pp. 1775-1776

19 M Slessarev, J Cheng, M Ondrejicka, et al. Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia Can J Anesth., 67 (2020), pp. 1288-1290

20 P. Quah, A. Li, J. Phua, et al. Mortality rates of patients with COVID-19 in the intensive care unit: A systematic review of the emerging literature Crit Care., 24 (2020), pp. 1-4

21 RH Du, LM Liu, W. Yin, et al. Hospitalization and critical care of 109 decedents with COVID-19 pneumonia in Wuhan, China Ann Am Thorac Soc., 17 (2020), pp. 839-846

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