Prone positioning is an established intervention in mechanically ventilated acute respiratory distress syndrome (ARDS) patients, with demonstrated reductions in mortality. Preliminary data suggest that awake proning in patients with COVID-19 treated with high-flow nasal oxygenation (HFNO) improves gas exchanges, and might be associated with a reduced need of mechanical ventilation, and reduced mortality. Further investigation in a formal randomized-controlled trial is need.
Procedure: Awake Prone Positioning
Patients will receive instruction to remain in prone position as long and as often as possible, up to 16h/24h
Procedure: Standard care
Patients will not receive any special instructions with regards to proning.
Inclusion Criteria:
- COVID-19, either confirmed by SARS-CoV-2 assay, or clinically suspected, with results
of the assay pending;
- Lung infiltrates documented on chest X-ray or chest CT-scan;
- Significant respiratory distress that requires treatment with HFNO.
Exclusion Criteria:
- Unable to consent;
- Unable to prone;
- Indication for immediate endotracheal intubation and mechanical ventilation;
- Contraindication to prone positioning (severe obesity, abdominal wound, pregnancy,
unstable pelvic/spinal lesions, vomiting, etc.);
- Comfort care or imminent expectation of death.
Hôtel-Dieu de Gaspé
Gaspé, Quebec, Canada
Hôpital de la Cité-de-la-Santé
Laval, Quebec, Canada
Montreal General Hospital, McGill University Healthcare Center
Montréal, Quebec, Canada
Royal Victoria Hospital, McGill University Healthcare Center
Montréal, Quebec, Canada
Hôpital de Verdun
Montréal, Quebec, Canada
Ivan Pavlov, MD, Principal Investigator
Hôpital de Verdun