Global study suggests new treatment approach for critically-ill Covid patients

Critically-ill Covid-19 patients are less likely to die or to require invasive ventilation if lying on their stomachs while receiving oxygen, a global research project has found.

The impact of the technique, known as awake prone positioning, was assessed in hospitals in six countries and involved more than 1,000 coronavirus patients requiring advanced breathing support.

The findings of the study, sponsored by NUI Galway, have been published in The Lancet Respiratory Medicine.

It was the first clinical trial of its kind into the practice of awake prone positioning and ran from April 2020 to January 2021.

It showed that putting patients in this position while they received high flow nasal cannula oxygen reduced death and the need for invasive mechanical ventilation.

Dr Bairbre McNicholas, honorary senior lecturer at NUI Galway and intensive care consultant at University Hospital Galway, said: “Providing an evidence base for what we do in the intensive care unit is critical so that we support and implement recommendations that work.

“This study, which was part of a global effort and was sponsored locally by NUI Galway and the Health Research Board Clinical Research Facility Galway, as part of its response to the Covid-19 pandemic, shows that clinical trials can be scaled up and done properly and efficiently during a pandemic and demonstrates what we can achieve when we work together.”

The study involved 1,121 patients in the US, Canada, Mexico, France, Spain and Ireland, and it is the first time awake prone positioning has been studied to such an extent.

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Some of the key findings of the study include:

– Awake prone positioning reduces death and the need for invasive intubation in patients with severe Covid-19 who require high flow nasal cannula oxygen.

– The technique is safe and well-tolerated by patients.

– Blood oxygen levels are significantly improved in patients who adopt awake prone positioning.

– The longer patients can sustain being in prone positioning, the greater the success of the treatment and the less likely they are to need invasive mechanical ventilation.

Dr Bairbre McNicholas, honorary senior lecturer at NUI Galway and intensive care consultant at University Hospital Galway (NUI Galway PA)
Dr Bairbre McNicholas, honorary senior lecturer at NUI Galway and intensive care consultant at University Hospital Galway (NUI Galway PA)

Dr McNicholas said: “I tell patients that going on your tummy will improve the oxygen levels in your blood, that, although it is uncomfortable, the longer you can put up with this position, the less likely you will need to go on to require needing a breathing tube.”

Lisa Power was treated using awake prone positioning while a Covid patient at University Hospital Galway.

She said: “It really helped my breathing and made me much more comfortable without having to put me on a ventilator.”