Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Assessment of Awake Prone Positioning in Hospitalized Adults With COVID-19

Edward T. Qian, Cheryl L. Gatto, Olga Amusina, Mary Lynn Dear, William Hiser, Reagan Buie, Sunil Kripalani, Frank E. Harrell, Robert E. Freundlich, Yue Gao, Wu Gong, Cassandra Hennessy, Jillann Grooms, Megan Startzell, Shashi Bellam, Jessica G. Burke, Arwa Zakaria, Eduard E. Vasilevskis, Frederic T. Billings, Jill M. Pulley, Gordon R. Bernard, Christopher J. Lindsell, Todd W. Rice, Vanderbilt Learning Healthcare System Platform Investigators, Robert S. Dittus, Shon Dwyer, Paul A. Harris, Tina V. Hartert, Jim Hayman, Catherine H. Ivory, Kevin M. Johnson, Ruth Kleinpell, Lee Ann Liska, Patrick Luther, Jay Morrison, Thomas Nantais, Mariann R. Piano, Kris Rhem, Russell L. Rothman, Matt Semler, Robin Steaban, Philip Walker, Consuelo H. Wilkins, Adam Wright, Autumn D. Zuckerman

JAMA Internal Medicine · 2022

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Summary

This pragmatic trial of 501 COVID-19 patients with hypoxaemia assessed whether recommendation of awake prone positioning improved clinical outcomes compared with usual care across two US academic medical centres. Patients in the intervention group spent a median of 4.2 hours daily in the prone position versus 0 hours in usual care. The study employed Bayesian proportional odds modelling to evaluate outcomes on a modified WHO severity scale, though specific efficacy results are not disclosed in the abstract provided.

UK applicability

These findings from US hospital settings may have limited direct applicability to UK practice, as clinical protocols, patient populations, and resource availability differ. However, results could inform UK guidance on non-invasive respiratory support strategies for hypoxaemic COVID-19 patients, should the trial demonstrate clinical benefit.

Key measures

Modified WHO ordinal outcome scale (worst hypoxaemia on day 5), progression to mechanical ventilation, hospital mortality, duration of prone positioning per day (median hours)

Outcomes reported

The study measured clinical outcomes using a modified World Health Organization ordinal outcome scale, assessing worst hypoxaemia level on study day 5 and subsequent progression to mechanical ventilation or death. Primary analysis employed Bayesian proportional odds modelling with covariate adjustment for baseline clinical severity.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
Pragmatic nonrandomised controlled trial
Source type
Peer-reviewed study
Status
Published
Geography
United States
System type
Human clinical
DOI
10.1001/jamainternmed.2022.1070
Catalogue ID
BFmoso8xrl-5na2tk

Topic tags

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