Role of Prone Position in Acute Hypoxemic COVID-19 Patients with Spontaneous Ventilation: A Randomized Controlled Study

Background: The COVID-19 pandemic has prompted the need for novel treatments for acute hypoxemic respiratory failure. Prone positioning, a method previously reserved for severe ARDS, is now being explored for its benefits in non-intubated COVID-19 patients to improve oxygenation and potentially decrease the reliance on mechanical ventilation and ICU care. Aim: To evaluate if prone positioning alongside standard treatment enhances outcomes in acute hypoxemic COVID-19 patients, focusing on ICU admission, mechanical ventilation rates, oxygenation, hospital stay, and 28-day mortality compared to standard treatment alone. Material and Methods: This prospective, randomized controlled study involved 90 COVID-19 patients, divided into Group P (proning plus standard care, n=45) and Group S (standard care alone, n=45) admitted to Tanta University Hospitals. The study assessed the impact of prone positioning on ICU admission rates, mechanical ventilation use, oxygenation improvement, hospital stay duration, and 28th-day mortality. Results: Improvements in PaO2/FiO2 and SpO2/FiO2 ratios were significantly better in Group P after 24 hours and at the endpoint (p values 0.031 and 0.014; 0.028 and 0.035, respectively). Inflammatory markers and lymphocyte counts improved significantly in Group P at the endpoint. No significant difference was observed in mechanical ventilation use, cardiac arrest, or 28-day mortality between the groups. The incidence of ICU admission was significantly lower in group P than group S (P value =0.038). Conclusions: Prone positioning could be an effective adjunct therapy in the management of moderate COVID-19-induced respiratory failure, potentially alleviating ICU resource strain.