Evaluation of awake prone positioning effectiveness in moderate to severe COVID-19 (Awake Prone Study)

Funder: Wellcome Trust
Principal Investigator: Nguyen Thanh Truong, Louise Thwaites
Location of activity: Hospital for Tropical Diseases (including other hospital belong to HTD), Ho Chi Minh City, Vietnam

Background
Supplemental oxygen is recommended to maintain oxygen saturations in those with COVID-19 associated acute respiratory failure. Many patients require escalation of therapy, from simple low-flow systems to higher flow methods, non-invasive ventilation or endotracheal intubation and invasive mechanical ventilation. Escalation of therapy necessitates increased utilisation of healthcare resources such as oxygen, equipment and skilled staff. Whilst already in short supply in resource-limited countries, these are even further limited in the current pandemic situation.

In patients with severe acute respiratory distress syndrome (ARDS) receiving mechanical ventilation, prone position has been shown to increase survival and respiratory outcomes.
However, it is unclear whether patients on lower degrees of respiratory support (eg oxygen via facemask or nasal canulae) also benefit, nor whether data from well-resourced healthcare environments apply in LMICs such as Vietnam, particularly under pandemic situations when considerable resources are required to help patients maintain prone positioning.

Primary objective
To determine whether prone positioning of hospitalized Vietnamese patients with moderate to severe COVID-19 for ≥ 8 hours a day reduces the need for escalation of respiratory therapy compared to standard care.

Secondary objectives
1. To determine whether prone positioning with a protocol aiming for ≥ 8 hours a day results in reduced intubation rates, improved mortality and shorter duration of hospital stay compared to standard care.
2. To compare changes in FiO2, SpO2, respiratory rate and heart rate that occur during prone position of hospitalized Vietnamese patients with moderate to severe COVID-19.
3. To determine whether prone positioning for ≥ 8 hours a day is associated with reduced oxygen utilisation compared to standard care.
4. To determine safety of prone positioning.