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Am Fam Physician. 2022;106(2):online

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: 1,985 patients from 10 randomized controlled trials (RCTs) who had acute hypoxemic respiratory failure due to COVID-19

Efficacy End Points: Primary outcome was cumulative intubation risk; secondary outcomes included all-cause mortality, the need for escalating respiratory support, need for transfer to the intensive care unit (ICU), and duration of ICU and hospital stay

Harm End Points: Cardiac arrest, vomiting, and central or arterial line dislodgement

GreenBenefits greater than harms
YellowUnclear benefits
RedNo benefits
BlackHarms greater than benefits

Narrative: Prone positioning may improve oxygenation in intubated patients with acute respiratory distress syndrome.1 Some studies have suggested that prone positioning may prevent the need for intubation in patients with acute hypoxemic respiratory failure who are awake and not intubated.2,3 Physiologically, prone positioning improves lung aeration through recruitment of dorsal alveoli, which reduces blood shunting in areas with collapsed or nonaerated alveoli.4 This practice in patients who are intubated and sedated requires multiple staff members to change the patient's position several times per day and may result in disconnection or dislodgement of central or arterial lines.

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This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

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