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In this issue of JAMA Internal Medicine, Thompson and colleagues report the association of prone positioning with pulse oximetry in 25 awake, nonintubated patients with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19).1 This study included patients who were hypoxemic (oxyhemoglobin saturation [Spo2] ≤ 93%) despite receiving 15 L/min oxygen by face mask and 6 L/min oxygen by nasal cannula and excluded patients who were unable to turn in bed without assistance and those determined to be in respiratory distress and requiring immediate intubation. The median (SE) improvement in oxygen saturation was 7% (1.2%) (95% CI, 4.6%-9.4%) after 1 hour of prone positioning. This study adds to a growing body of literature suggesting that prone positioning may improve oxygenation in patients with early acute respiratory distress syndrome (ARDS) prior to intubation.
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Corresponding Author: Carolyn S. Calfee, MD, MAS, Department of Anesthesia, University of California, San Francisco, 505 Parnassus Ave, Box 0111, San Francisco, CA 94143-0111 (email@example.com).
Published Online: June 17, 2020. doi:10.1001/jamainternmed.2020.3027
Conflict of Interest Disclosures: Dr Calfee reported grants from the National Institutes of Health during the submitted work, and grants from Roche/Genentech and Bayer and personal fees from Quark, GEn1E Lifesciences, CSL Behring, Prometic Life Sciences (now Liminal BioSciences), and Vasomune Therapeutics outside the submitted work. No other disclosures were reported.
Funding/Support: The work was supported by grants from the National Institutes of Health (HL140026, Dr Calfee; HL151117, Dr Sarma).
Role of the Funder/Sponsor: The National Institutes of Health had no role in the preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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