ArticleCritical care (London, England)2022
Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study.
Article in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Guideline on positioning and early mobilisation in the critically ill by an expert panel.Intensive care medicine · 2024Guideline
- Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis.Critical care science · 2024Pooled it
- Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxic respiratory failure: a systematic review based on eight high-quality randomized controlled trials.BMC infectious diseases · 2023Pooled it
- Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis.European journal of medical research · 2022Pooled it
- Effect of Awake Prone Positioning in non-Intubated COVID-19 Patients with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis.Journal of intensive care medicine · 2022Pooled it
- Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis.The Lancet. Respiratory medicine · 2022Pooled it
- Awake Prone Positioning in Patients With COVID-19 Respiratory Failure: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Effects of innovative modular prone positioning tools in patients with acute respiratory distress syndrome due to COVID-19 during awake prone position: a prospective randomized controlled trial.European journal of medical research · 2024Trial
- Trial
- Prolonged vs shorter awake prone positioning for COVID-19 patients with acute respiratory failure: a multicenter, randomised controlled trial.Intensive care medicine · 2024Trial
- [Effect of awake prone positioning in non-intubated patients with community-acquired pneumonia complicated by hypoxemia].Medecine tropicale et sante internationale · 2025Review
- A predictive model for early intubation in patients with COVID-19-induced acute hypoxemic respiratory failure under awake prone position.Annals of intensive care · 2025Article
- Reconsidering methodological choices and future research avenues in awake prone positioning studies. Author's reply.Intensive care medicine · 2025Article
- Effectiveness of bundle of care on tolerance of awake-prone positioning in patients with acute respiratory failure. A multicenter observational study.Intensive care medicine · 2025Observational
- Early physiologic changes after awake prone positioning predict clinical outcomes in patients with acute hypoxemic respiratory failure.Intensive care medicine · 2024Article
- Effectiveness and safety of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure: an overview of systematic reviews.BMC pulmonary medicine · 2024Review
- Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves.Critical care science · 2024Article
- Article
- Prone Positioning for Patients With COVID-19-Induced Acute Hypoxemic Respiratory Failure: Flipping the Script.Respiratory care · 2023Review
- Factors Associated With Prolonged Ventilation in Patients Receiving Prone Positioning Protocol With Muscle Relaxants for Severe COVID-19 Pneumonia.Respiratory care · 2023Article
Corrections and comments
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP.
methodsThis multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting-propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality.
resultsDuring the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25-75)] 12 (9-16) h/day and 148 (44%) served as controls. The IPW-propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2-0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19-1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17-0.8)].
conclusionIn the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.
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