Photo Credit: KatarzynaBialasiewicz

The following is a summary of “Effect of early and later prone positioning on outcomes in invasively ventilated COVID-19 patients with acute respiratory distress syndrome: analysis of the prospective COVID-19 critical care consortium cohort study,” published in the February 2025 issue of Annals of Intensive Care by Simpkin et al. 

Prone positioning was widely used for individuals with COVID-19 receiving invasive mechanical ventilation (IMV), though evidence of its efficacy remained limited.  

Researchers conducted a retrospective study to examine the association between prone positioning (PP) and mortality, with a focus on treatment timing.  

They analyzed the incidence, demographic characteristics, management, and outcomes of individuals who underwent PP while receiving IMV for COVID-19. Outcomes were compared between those placed in the PP within 48 hours of IMV and 2 groups: individuals who were never placed in the PP and those who underwent PP only after 48 hours.  

The results showed that among 3,131 individuals with PP data, 1,482 (47%) were never placed in the PP, 1,034 (33%) were prone within 48 hours, and 615 (20%) were prone after 48 hours of starting IMV. Those prone within 48 hours had lower mortality risks at 28 days (hazard ratio [HR] 0.82; 95% CI 0.68-0.98; P = 0.03) and 90 days (HR 0.81; 95% CI 0.68-0.96; P = 0.02) compared to individuals who were never prone. However, PP beyond 48 hours showed no significant association with 28-day (HR 0.93; 95% CI 0.75-1.14; P = 0.47) or 90-day mortality (HR 0.95; 95% CI 0.78-1.16; P = 0.59).  

Investigators concluded the PP as beneficial for patients with COVID-19, its effectiveness was not observed when initiated later during the treatment. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01422-6