Non intubated prone positioning in intensive care, feasibility and indications
Keywords:Prone position, Awake prone position, Acute respiratory distress syndrome, Acute respiratory failure, COVID-19
Prone positioning of non-intubated patients has been exceptionally popular during the COVID-19 pandemic. In this update, after covering the physiopathological rationale underlying this practice, the indications, contraindications as well as the feasibility are discussed. The scientific data from many observational studies but also from randomized trials are reviewed before considering the practical aspects of placing non-intubated intensive care patients in the prone position. Strong data suggest a benefit in terms of reducing the need for intubation in patients with hypoxemic acute respiratory failure related to COVID-19 with a good feasibility of the technique and few side effects. The indications are broad in these patients and it is advisable to target a daily duration of prone positioning of at least eight hours. Beyond that, additional work is needed to assess the potential benefits of the technique in other patients groups.