Placing hospitalized patients with severe coronavirus -not intubated- in a prone position, i.e., face down, improves their prognosis and reduces the need for intubation and therefore, of mortality, according to the results of an international clinical trial conducted in 42 hospitals in six countries, including the Spanish hospitals Vall d’Hebron and Hospital del Mar.
This study has been published by the scientific journal ‘The Lancet Respiratory Medicine’, and it is the first major research that analyzes the benefits of this position shift, which opens the door to a change in current clinical practice to incorporate this treatment as part of the medical routine for patients not intubated with Covid-19.
This international study has scientifically demonstrated that placing the seriously ill person with coronavirus on his or her back improves the course of treatment with high-flow oxygen therapy, which is applied when there is severe acute respiratory failure, in this case, caused by the coronavirus.
“The scientific evidence of the efficacy of this technique in non-intubated patients is especially important during the peak of the pandemic when there may be a shortage of respirators. This is the first major research that analyzes the benefits of a position change in awake patients who do not need a respirator, that is, who breathe spontaneously by themselves, as part of the treatment in Covid-19 patients”, explained the medical coordinator of the ICU of the Vall d’Hebron Hospital, Oriol Roca.
The trial involved 1,126 patients admitted between April 2020 and January 2021. Half of them, the control group, were treated with the usual protocol, and the other half, the experimental group, were positioned in prone decubitus for at least one hour a day, in a minimum of two sessions of 30 minutes, and with an average of 5 hours daily.
In the control group, 46% of patients needed intubation or had a fatal prognosis until 28 days after inclusion in the study. This percentage was reduced to 40% among patients in the experimental group, who had spent time in prone decubitus. In the latter group, all breathing indicators improved in the first session, and the improvement was maintained upon return to the supine position.
According to doctors, avoiding intubation reduces the risk of suffering complications from this cause, and also implies a collective benefit by having less need for respirators, one of the equipment with less availability in many countries.
The trial concludes that the use of this measure is safe and very simple to apply and does not cause any cost, or associated risks.