(HealthDay News) — For hospitalized patients with acute hypoxic respiratory failure due to COVID-19 who require respiratory support with a high-flow nasal cannula, awake prone positioning may reduce the need for intubation, according to a study published online Aug. 20 in The Lancet Respiratory Medicine.
Stephan Ehrmann, M.D., Ph.D., from CHRU Tours in France, and colleagues conducted a prospective collaborative meta-trial of six open-label superiority trials among adults who required respiratory support with a high-flow nasal cannula for acute hypoxemic respiratory failure due to COVID-19. A total of 1,126 patients at hospitals from six counties were randomly assigned to awake prone positioning or standard care (567 and 559, respectively); 1,121 were included in the intention-to-treat analysis.
The researchers found that treatment failure occurred in 40 and 46% of patients assigned to awake prone positioning and standard care, respectively (relative risk, 0.86; 95% confidence interval, 0.75 to 0.98). Compared with standard care, the hazard ratio with awake prone positioning was 0.75 (95% confidence interval, 0.62 to 0.91) for intubation and 0.87 (95% confidence interval, 0.68 to 1.11) for mortality. Both groups had a low incidence of prespecified adverse events.
“Our findings support the routine implementation of awake prone positioning in critically ill patients with COVID-19 requiring high flow nasal cannula oxygen therapy,” Ehrmann said in a statement. “It appears important that clinicians improve patient comfort during prone positioning, so the patient can stay in the position for at least eight hours a day.”
Several authors disclosed financial ties to the biopharmaceutical and medical device industry.
