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The research has been carried out in several countries, such as Spain, the United States, Mexico, France, Canada and Ireland.
A clinical study carried out in six countries with more than 1.100 patients hospitalized with covid-19 who required oxygen suggests that prone positioning (turning patients with severe breathing problems to face down) shortly after admission may significantly reduce the need for mechanical ventilation.
The results, published in the journal 'The Lancet Respiratory Medicine', come from a meta-trial carried out in medical centers in United States, Mexico, France, to Canada, Ireland y Spain in seriously ill patients with covid-19 between April 2020 and January 2021.
There are several interventions to improve oxygenation in critically ill patients. However, there is little clinical evidence focused on the outcomes that demonstrate that prone positioning before mechanical ventilation is beneficial.
In this innovative essay, the authors hypothesized that prone positioning effectively reduced the need for mechanical ventilation in critically ill patients with Covid-19. Adult patients with covid-19 who needed respiratory assistance with a high-flow nasal cannula, and who agreed to participate in this clinical trial, were randomly assigned to the supine or prone position groups.
They were asked to remain in that position for as long as they could tolerate. Both the supine and prone groups received high-flow oxygen therapy and standard medical treatment.
The patients were monitored continuously to determine if mechanical ventilation was necessary. Data from this study showed that the prone positioning group was significantly less likely to require mechanical ventilation (33% in the awake prone positioning group vs. 40% in the supine group).
"Our findings support the routine implementation of awake prone positioning in critically ill Covid-19 patients requiring high-flow nasal cannula oxygen therapy. It seems important for clinicians to improve patient comfort during prone positioning, so that the patient can remain in the position for at least 8 hours a day," argues Stephan Ehrmann, another of those responsible for the research.
