Awaken Prone Positioning Ventinlation in COVID-19 Patients

Awaken prone positioning (APP) ventilation has been widely accepted as a standard regimen in the management of COVID-19 patients. Physiological studies have proved ventilation/perfusion improvement during APP in COVID-19, which was associated improved oxygenation. However, the optimal duration for APP was not yet demonstrated. In this study, we aimed at the prolonged APP to see whether this could improve patients outcomes.

Inclusion Criteria:Aged > 18-yr to 85-yrSevere COVID-19 pneumonia (with typical radiographic alternations) and non-intubated patients.SpO2 <= 93% with ambient air at rest.PaO2/FiO2 <= 300 mmHgExclusion Criteria:Definite intolerance to APP (e.g. pregnancy, extremity deformity, recent fracture, open thoracic or abdomial surgery, pace-maker implant in recent 48-hr, spine stability, pelvis or facial fractures, predicted difficult airway)morbidity obesity, BMI > 40consciousness disorder (GCS < 13), delirium dementiahemodynamic instability (with norepinephrine > )NYHA Grade III or IVSevere hemoptysislong term home oxygenation of CPAPRefuse invasive mechanical ventilation (DNI DNR)