Awake Prone Position in Patients with Acute Hypoxic Respiratory Failure: A Narrative Review

Prone position for mechanically ventilated patients with moderate to severe acute respiratory distress syndrome (ARDS) has been shown to improve oxygenation and decrease mortality if applied for more than 12 hours per day. When the coronavirus disease 2019 (COVID-19) pandemic challenged the globe, healthcare systems were faced with scarcity of resources and mechanical ventilators. Awake prone position was one of the interventions which was used to reduce the need for intubation and invasive mechanical ventilation. Several observational and randomized controlled trials were published with differing results. This was due to several factors including the variable duration of prone position, the timing of initiation, and the various supportive ventilatory devices used during awake proning. This review aims to describe the physiological responses to awake prone positioning, provide and summary the body of evidence for the utility of awake prone positioning in hypoxemic respiratory failure, and identify knowledge gaps for future research.