Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review

• Published in: Indian journal of critical care medicine Vol. 25; no. 8; pp. 896 - 905
• Main Authors: Chilkoti, Geetanjali T, Mohta, Medha, Saxena, Ashok K, Ahmad, Zainab, Sharma, Chhavi S
• Format: Journal Article
• Language: English
• Published: India Jaypee Brothers Medical Publishers 01-08-2021
• Subjects: Review; COVID-19 pneumonia; Prone positioning; Management
• ISSN: 0972-5229; 1998-359X
• DOI: 10.5005/jp-journals-10071-23932

The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration.
A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted.
We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% (
= 1,093) and 21.0% (
= 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes.
We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor.
Chilkoti GT, Mohta M, Saxena AK, Ahmad Z, Sharma CS. Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review. Indian J Crit Care Med 2021;25(8):896-905.