Corresponding Author: Waleed Alhazzani, MD, MSc, Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada (waleed.al-hazzani@medportal.ca).
Accepted for Publication: April 26, 2022.
Published Online: May 15, 2022. doi:10.1001/jama.2022.7993
Author Contributions: Drs Alhazzani and Arabi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Parhar, Weatherald, Al Duhailib, Fan, Lauzier, Rochwerg, Culgin, Nelson, Fiest, Stelfox, Solverson, Niven, Møller, Belley-Cote, Thabane, Cook, Arabi.
Acquisition, analysis, or interpretation of data: Alhazzani, Parhar, Weatherald, Al Duhailib, Alshahrani, Al-Fares, Buabbas, Cherian, Munshi, Fan, Al Hameed, Chalabi, Rahmatullah, Duan, Tsang, Lewis, Lauzier, Centofanti, Culgin, Nelson, Abdukahil, Fiest, Stelfox, Tlayjeh, Meade, Perri, Solverson, Lim, Møller, Belley-Cote, Thabane, Tamim, Cook.
Drafting of the manuscript: Alhazzani, Parhar, Weatherald, Al Duhailib, Chalabi, Lewis, Centofanti, Culgin, Nelson, Møller, Tamim, Arabi.
Critical revision of the manuscript for important intellectual content: Alhazzani, Parhar, Weatherald, Al Duhailib, Alshahrani, Al-Fares, Buabbas, Cherian, Munshi, Fan, Al Hameed, Rahmatullah, Duan, Tsang, Lewis, Lauzier, Centofanti, Rochwerg, Culgin, Nelson, Abdukahil, Fiest, Stelfox, Tlayjeh, Meade, Perri, Solverson, Niven, Lim, Møller, Belley-Cote, Thabane, Cook, Arabi.
Statistical analysis: Alhazzani, Al Duhailib, Møller, Thabane, Tamim, Arabi.
Obtained funding: Alhazzani, Parhar, Weatherald, Al Duhailib, Duan, Lauzier, Culgin, Fiest, Stelfox, Meade, Perri, Solverson, Niven, Belley-Cote, Cook, Arabi.
Administrative, technical, or material support: Alhazzani, Parhar, Weatherald, Alshahrani, Al-Fares, Buabbas, Cherian, Munshi, Rahmatullah, Duan, Tsang, Centofanti, Rochwerg, Culgin, Nelson, Abdukahil, Fiest, Tlayjeh, Perri, Solverson, Belley-Cote, Cook, Arabi.
Supervision: Alhazzani, Parhar, Weatherald, Alshahrani, Al-Fares, Al Hameed, Duan, Culgin, Nelson, Møller, Thabane, Cook, Arabi.
Conflict of Interest Disclosures: Dr Parhar reported receiving Rapid COVID-19 grants from the Cumming School of Medicine at the University of Calgary and Alberta Innovates. Dr Weatherald reported receiving Rapid COVID-19 grants from the Cumming School of Medicine at the University of Calgary; receiving grants, personal fees, and nonfinancial support from Janssen, Actelion, and Bayer; and receiving personal fees from Acceleron and Merck. Dr Alshahrani reported receiving grants from King Abdullah International Medical Research Center. Dr Fan reported receiving personal fees from ALung Technologies, Baxter, Aerogen, Inspira, GE Healthcare, and Vasomune. Dr Belley-Cote reported receiving grants from Bayer, Bristol Myers Squibb-Pfizer Alliance, and Roche Diagnostics. No other disclosures were reported.
Funding/Support: The trial was supported by peer-review grants from the Canadian Institute of Health Research and King Abdullah International Medical Research Center in Saudi Arabia and a McMaster University COVID-19 research grant.
Role of the Funder/Sponsor: The funders/sponsors 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.
Group Information: The COVI-PRONE Trial Investigators and the Saudi Critical Care Trials Group members are listed in Supplement 4.
Meeting Presentation: This was presented at the American Thoracic Society International Conference; May 15, 2022; San Francisco, California.
Data Sharing Statement: See Supplement 5.
Additional Contributions: We thank the patients and families participating in this trial. We also thank the collaborating research coordinators and investigators and the bedside clinicians who supported this work. We specifically thank Kelly Hassall, RRT (St Joseph’s Healthcare Hamilton; did not receive financial compensation), and France Clarke, RRT (McMaster University; did not receive financial compensation), who were instrumental in championing the trial with their respiratory therapy colleagues and respective societies, Joshua Piticaru, MD (McMaster University; did not receive financial compensation), for producing prone positioning educational material, and Tom Piraino, RRT (University of Toronto; did not receive financial compensation), for his contributions to the trial design. We thank Melanie Columbus, PhD (University of Calgary; received financial compensation), Olesya Dmitrieva, BHSc (University of Calgary; received financial compensation), and Cassidy Codan, BSc (University of Calgary; received financial compensation), for serving as research coordinators. We also thank Kelly Nelson, RN (St Joseph’s Healthcare Hamilton; received financial compensation), for her role in the methods center with data cleaning and Will Cullimore (St Joseph’s Healthcare Hamilton; received financial compensation) for creating the trial’s website and social media platforms. We are grateful to the Canadian Society of Respiratory Therapists, the Canadian Critical Care Society, and the Alberta Health Services Critical Care Strategic Clinical Network for endorsing and supporting the trial grant application.
Additional Information: Dr Alhazzani holds a McMaster University Department of Medicine Mid-Career Research Award. Dr Cook holds a Canada Research Chair.