The study aims to evaluate if the early prone-positioning in awake patients with mild Covid-19 pneumonia can reduce the need of high-flow oxygen-therapy, invasive or non-invasive ventilation and prevent the worsening of clinical conditions. Patients will be randomized on a 1:1 ratio and stratified based on the onset of symptoms (10 days) and need of oxygen therapy (no need; need). One branch of patients (interventional) will undergo standard of care treatment + prone-positioning cycles, the other one (controll) will undergo standard of care treatment alone. Patients will be evaluated evaluated on the day of the enrolment, on day 1, day 3, day 7 and every 7 days until the patient dismissal or until day 28 (whichever occurs first). Adverse events and concurrent medications will be noted as well. The analysis will be conducted according to "intention to treat" criteria; primary outcomes will be calculated using survival-based methods.
In this prospective, unicentred, open, controlled study, patients will be randomized on a 1:1
ratio using casual permutation blocks, identifying two branches of treatment: standard of
care; standard of care + prone positioning. Patients will be stratified in 4 strata based on
the onset of symptoms (<10 days; >10 days) and need of oxygen therapy (no need; need).
In order to obtain statistical significance, the sample size will include 96 patients.
Patients in the SOC + prone-positioning branch will undergo cycles of prone-positioning
following this scheme: 3-6 hours of prone-positioning twice a day. The actual length of the
cycles will be registered during the study.
Data will be collected using a dedicated CRF, which will include recording of adverse events
and concurrent medications.
Patients will be evaluated on the day of the enrolment, on day 1, day 3, day 7 and every 7
days until the patient dismissal or until day 28 (whichever occurs first). If dismissal
occurs before day 28, a follow-up interview will be conducted in presence or on the phone to
collect the remaining data.
The analysis will be conducted according to "intention to treat" criteria; primary outcomes
will be calculated using survival-based methods (Kaplan-Meier curves with log-rank test and
Cox regression), while secondary outcomes will be evaluated using both survival-based methods
and proportional odds model.
The occurrence of adverse events and the causes of withdrawal from the study in the two
branches of treatment will be compared using chi-square test.
Procedure: prone positioning
3-6 hours of prone-positioning twice a day
Inclusion Criteria:
- > 18 years
- positive PCR for Sars-Cov-2 Rna on any respiratory samples within 7 days from
enrollment
- imaging positive for pulmonary involvement or clinical evidence of respiratory
involvement ( new onest of hypoxemia with 02 <80mmHg or SpO2 < 94% in air or need for
oxygen therapy in oreder to mantaine SpO2 > 93%.
- need of hospitalization
Exclusion Criteria:
- start of prone-positioning cycles before being enrolled in the study
- SpO2/FiO2 <200
- need of high-flow oxygen therapy (HFNC) or need of non-invasive ventilation and/or
CPAP or indications for intubation and mechanical ventilation
- relative or absolute contraindications for prone positioning (eg facial fractures,
advanced pregnancy, mental status alterations, spinal instability...)
Asst-Monza Ospedale San Gerardo
Monza, Lombardia, Italy
Paolo Bonfanti, Principal Investigator
asst-monza Ospedale San Gerardo