Self-Proning in COVID-19 Patients on Low-Flow Oxygen Therapy: A Cluster Randomised Controlled Trial

Rationale: Prone positioning as a complement to oxygen therapy to treat hypoxemia in coronavirus disease (COVID-19) pneumonia in spontaneously breathing patients has been widely adopted, despite a lack of evidence for its benefit.Objectives: To test the hypothesis that a simple incentive to self-prone for a maximum of 12 h per day would decrease oxygen needs in patients admitted to the ward for COVID-19 pneumonia on low-flow oxygen therapy. Methods: Twenty-seven patients with confirmed COVID-19 pneumonia admitted to Geneva University Hospitals were included in the study. Ten patients were randomised to self-prone positioning and 17 to usual care. Measurements and Main Results: Oxygen needs assessed by oxygen flow on nasal cannula at inclusion were similar between groups. Twenty-four hours after starting the intervention, the median oxygen flow was 1·0 L/min (interquartile range, 0·1-2·9) in the prone position group and 2·0 L/min (interquartile range, 0·5-3·0) in the control group (P = 0·507). Median oxygen saturation/fraction of inspired oxygen ratio was 390 (interquartile range, 300-432) in the prone position group and 336 (interquartile range, 294-422) in the control group (P = 0·633). One patient from the intervention group who did not self-prone was transferred to the high-dependency unit. Self-prone positioning was easy to implement. The intervention was well tolerated and only mild side-effects were reported. Conclusions: Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.Trial Registration: The study was registered on the Swiss National Clinical Trial portal (SNCTP000003718).Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: The institutional ethics review committee approved the trial (CCER 2020-00705). All participants provided written informed consent before screening.