Awake prone positioning in COVID-19
David Koeckerling, Joseph Barker, Nadeesha Lakmal Mudalige, Oluwatobiloba Oyefeso, Daniel Pan, Manish Pareek, Jonathan P. Thompson, G. André Ng
Abstract
In the absence of effective targeted therapies for COVID-19, optimisation of supportive care is essential. Lung injury with features of acute respiratory distress syndrome (ARDS) appears to be the principal characteristic of severe acute respiratory syndrome coronavirus 2 infection.<a href="https://thorax.bmj.com/content/early/2020/06/15/thoraxjnl-2020-215133#ref-1">1</a> Recent guidance by the UK Intensive Care Society (ICS) advocates awake prone positioning to become standard of care for suspected or confirmed COVID-19, in patients requiring an FiO2 ≥28%0.<a href="https://thorax.bmj.com/content/early/2020/06/15/thoraxjnl-2020-215133#ref-2">2</a> These recommendations are extrapolated from physiological principles and clinical evidence obtained in a distinct study population—patients with severe ARDS undergoing invasive mechanical ventilation (IMV). [Opening paragraph]