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Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure

Educational Objective
To understand how the prone position can help awake, nonintubated patients with COVID-19 Hypoxemic Respiratory Failure
1 Credit CME

Critically ill patients with coronavirus disease 2019 (COVID-19) severely strained intensive care resources in New York City in April 2020.1 The prone position improves oxygenation in intubated patients with acute respiratory distress syndrome.2,3 We investigated whether the prone position is associated with improved oxygenation and decreased risk for intubation in spontaneously breathing patients with severe COVID-19 hypoxemic respiratory failure.46

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Article Information

Accepted for Publication: May 29, 2020.

Published Online: June 17, 2020. doi:10.1001/jamainternmed.2020.3030

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Thompson AE et al. JAMA Internal Medicine.

Corresponding Author: Sanja Jelic, MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, PH8 Center, Room 101, New York, NY 10032 (sj366@cumc.columbia.edu).

Author Contributions: Dr Jelic had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Thompson and Ranard served as co–first authors and contributed equally to the work.

Study concept and design: Thompson, Ranard, Jelic.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wei.

Obtained funding: Jelic.

Administrative, technical, or material support: Thompson, Ranard, Jelic.

Study supervision: Thompson, Ranard, Jelic.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) grants R01HL106041 and R01HL137234 (Dr Jelic).

Role of the Funder/Sponsor: The NIH/NHLBI had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: The study was registered on ClinicalTrials.gov on May 25, 2020, owing to the emergency nature of the treatment being administered based on clinical decision to critically ill patients with severe COVID-19 hypoxemic respiratory failure.

References
1.
City of New York. COVID-19: data. Accessed April 17, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
2.
Guérin  C , Reignier  J , Richard  JC ,  et al; PROSEVA Study Group.  Prone positioning in severe acute respiratory distress syndrome.   N Engl J Med. 2013;368(23):2159-2168. doi:10.1056/NEJMoa1214103PubMedGoogle ScholarCrossref
3.
Gattinoni  L , Taccone  P , Carlesso  E , Marini  JJ .  Prone position in acute respiratory distress syndrome. rationale, indications, and limits.   Am J Respir Crit Care Med. 2013;188(11):1286-1293. doi:10.1164/rccm.201308-1532CIPubMedGoogle ScholarCrossref
4.
Sun  Q , Qiu  H , Huang  M , Yang  Y .  Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province.   Ann Intensive Care. 2020;10(1):33. doi:10.1186/s13613-020-00650-2PubMedGoogle ScholarCrossref
5.
Pérez-Nieto  OR , Guerrero-Gutiérrez  MA , Deloya-Tomas  E , Ñamendys-Silva  SA .  Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS.   Crit Care. 2020;24(1):114. doi:10.1186/s13054-020-2821-yPubMedGoogle ScholarCrossref
6.
Ding  L , Wang  L , Ma  W , He  H .  Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study.   Crit Care. 2020;24(1):28. doi:10.1186/s13054-020-2738-5PubMedGoogle ScholarCrossref
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