• Ivan Pavlov, Jie Li, Aileen Kharat, Jian Luo, Miguel Ibarra-Estrada, Yonatan Perez, Bairbre McNicolas, Daniele Poole, Oriol Roca, David Vines, Elsa Tavernier, Thérèse Allen, Murali Shyamsundar, Stephan Ehrmann, Steven Q Simpson, Claude Guérin, and John G Laffey.
• Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada.
• J Crit Care. 2023 Dec 1; 78: 154401154401.

BackgroundAwake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios.MethodsAn international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.ResultsThe panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19.ConclusionAPP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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