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Invited Commentary
June 17, 2020

Prone Positioning in Awake, Nonintubated Patients With COVID-19: Necessity Is the Mother of Invention

Author Affiliations
  • 1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco
  • 2Department of Anesthesia, University of California, San Francisco
JAMA Intern Med. Published online June 17, 2020. doi:10.1001/jamainternmed.2020.3027

In this issue of JAMA Internal Medicine, Thompson and colleagues report the association of prone positioning with pulse oximetry in 25 awake, nonintubated patients with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19).1 This study included patients who were hypoxemic (oxyhemoglobin saturation [Spo2] ≤ 93%) despite receiving 15 L/min oxygen by face mask and 6 L/min oxygen by nasal cannula and excluded patients who were unable to turn in bed without assistance and those determined to be in respiratory distress and requiring immediate intubation. The median (SE) improvement in oxygen saturation was 7% (1.2%) (95% CI, 4.6%-9.4%) after 1 hour of prone positioning. This study adds to a growing body of literature suggesting that prone positioning may improve oxygenation in patients with early acute respiratory distress syndrome (ARDS) prior to intubation.

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    1 Comment for this article
    Prone postion in ARDS and PICs
    Camilo Colaco, PhD | ImmunoBiology Ltd
    The presence of microthrombi in CoVID-19 patients has been described as a variant of disseminated intravascular coagulation and could possibly result in some of the reductions in O2 saturation currently attributed to ARDS. Do the authors know what the d-dimer levels were in these patients and if there was any correlation with improvement?

    As a related question, are there other data available on d-dimer levels in CoVID-19 patients in the various studies on prone positioning that may distinguish those that are likely to benefit from awake proning?