Chi-ARDS Net
Trial question
What is the role of prolonged awake prone positioning in patients with COVID-19 infection with acute hypoxemic respiratory failure?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 409
409 patients (127 female, 282 male).
Inclusion criteria: patients with COVID-19 infection-related acute hypoxemic respiratory failure.
Key exclusion criteria: expected intolerance of awake prone positioning; morbid obesity; hemodynamic instability; cardiac dysfunction; severe hemoptysis; long-term home oxygenation or CPAP; DNI order.
Interventions
N=205 prolonged awake prone positioning (target > 12 hours daily for 7 days).
N=204 standard care (a shorter period of awake prone positioning).
Primary outcome
Rate of intubation within 28 days
17%
27%
27.0 %
20.3 %
13.5 %
6.8 %
0.0 %
Prolonged awake prone
positioning
Standard
care
Significant
decrease ▼
NNT = 10
Significant decrease in the rate of intubation within 28 days (17% vs. 27%; HR 0.56, 95% CI 0.37 to 0.86).
Secondary outcomes
Significant decrease in the rate of death within 28 days (19% vs. 27%; HR 0.63, 95% CI 0.42 to 0.96).
No significant difference in mean respiratory support-free days at 28 days (20.5 days vs. 18.4 days; MD 2.05, 95% CI -0.14 to 4.23).
Significant increase in mean invasive ventilation-free days at 28 days (22.2 days vs. 19.8 days; MD 2.33, 95% CI 0.06 to 4.61).
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with COVID-19 infection-related acute hypoxemic respiratory failure, prolonged awake prone positioning was superior to standard care with respect to the rate of intubation within 28 days.
Reference
Ling Liu, Qin Sun, Hongsheng Zhao et al. Prolonged vs shorter awake prone positioning for COVID-19 patients with acute respiratory failure: a multicenter, randomised controlled trial. Intensive Care Med. 2024 Aug;50(8):1298-1309.
Open reference URL