{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:39:27Z","timestamp":1785148767917,"version":"3.55.0"},"reference-count":36,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T00:00:00Z","timestamp":1671148800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Awake self-proning is being used widely as respiratory support in COVID-19 hypoxemia, in resource limited settings. We aimed to investigate the effectiveness of early awake self-proning in preventing mortality and need for intubation in adults with moderate COVID-19 hypoxemia. In this randomized clinical trial with intention-to-treat analysis, we enrolled eligible adults with COVID-19 hypoxemia (SpO2 &lt;94%), requiring supplemental oxygen via nasal prongs or facemask from a tertiary-care setting in Jodhpur, India between June 15 to December 24, 2020. Awake proning comprised of 4-hour cycles with prone position maintained 2 h per cycle. The control group did not maintain any specific position. All participants received standard care. The primary outcomes were 30-day mortality and requirement for mechanical ventilation. Of 502 participants included, mean (SD) age was 59.7 (12.7) years with 124 women (24.6%); 257 were randomized to awake-proning, 245 to control group and all 502 were included for follow-up mortality analysis. Mortality at follow-up was 16.3% in the awake-prone and 15.1% in the control group [OR:1.10 (0.68\u20131.78), p=0.703). Requirement of mechanical ventilation was 10% in both groups (p=0.974). Survival time (in days) was not significantly different between the groups [Log-rank test, HR: 1.08 (95% CI, 0.70\u20131.68), p=0.726]. Likewise, time to intubation was comparable (Log-rank test, HR: 0.93 (95% CI, 0.56\u20131.70), p=0.974). Hence, awake self-proning did not improve survival or requirement of mechanical-ventilation in non-intubated patients with mild to moderate COVID-19 hypoxemia. Trial Registration: Clinical trial registry of India, ID: CTRI\/2020\/06\/025804.\n***************************************************************\n\u00a0\n*Appendix Authors list \n\u00a0Deepak Kumar1, Gopal Krishna Bohra1, Nishant Kumar Chauhan2, Nikhil Kothari3, Vijaya Lakshmi Nag4 Sanjeev Misra5\n\u00a01Department of Internal Medicine; 2Department of Pulmonary Medicine;\u00a03Department of Anaesthesiology and Critical Care; 4Department of Microbiology; 5Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India<\/jats:p>","DOI":"10.4081\/monaldi.2022.2431","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T10:53:02Z","timestamp":1671187982000},"source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: An open-labelled randomized clinical trial from Jodhpur, India"],"prefix":"10.4081","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0661-9854","authenticated-orcid":false,"given":"Maya","family":"Gopalakrishnan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyendra","family":"Khichar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Saurabh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag","family":"Vijayvergia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthikeyan","family":"Thangaraju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swapnil","family":"Tripathi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshavardhan V.","family":"Devarakonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhilesh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranav S.","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9938-5024","authenticated-orcid":false,"given":"Mahendra Kumar","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2022,12,16]]},"reference":[{"key":"23482","doi-asserted-by":"crossref","unstructured":"Osuchowski MF, Winkler MS, Skirecki T, et al. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respir Med 2021;9:622\u201342.","DOI":"10.1016\/S2213-2600(21)00218-6"},{"key":"23483","doi-asserted-by":"crossref","unstructured":"Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA 2020;324:782\u201393.","DOI":"10.1001\/jama.2020.12839"},{"key":"23484","doi-asserted-by":"crossref","unstructured":"Grieco DL, Menga LS, Cesarano M, et al. Effect of Helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: The HENIVOT randomized clinical trial. JAMA 2021;325:1731\u201343.","DOI":"10.1001\/jama.2021.4682"},{"key":"23485","doi-asserted-by":"crossref","unstructured":"Carter C, Aedy H, Notter J. COVID-19 disease: Non-invasive ventilation and high frequency nasal oxygenation. Clin Integr Care 2020;1:100006.","DOI":"10.1016\/j.intcar.2020.100006"},{"key":"23486","doi-asserted-by":"crossref","unstructured":"Hallifax RJ, Porter BM, Elder PJ, et al. Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respir Res 2020;7:e000678.","DOI":"10.1136\/bmjresp-2020-000678"},{"key":"23487","doi-asserted-by":"crossref","unstructured":"Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, et al. Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study. Eur Respir J 2021;2100265.","DOI":"10.1101\/2021.01.27.21250631"},{"key":"23488","doi-asserted-by":"crossref","unstructured":"Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS with prone positioning. Chest 2017;151:215\u201324.","DOI":"10.1016\/j.chest.2016.06.032"},{"key":"23489","doi-asserted-by":"crossref","unstructured":"Kallet RH. A comprehensive review of prone position in ARDS. Respir Care 2015;60:1660\u201387.","DOI":"10.4187\/respcare.04271"},{"key":"23490","doi-asserted-by":"crossref","unstructured":"Coppo A, Bellani G, Winterton D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med 2020;8:765\u201374.","DOI":"10.1016\/S2213-2600(20)30268-X"},{"key":"23491","doi-asserted-by":"crossref","unstructured":"Stilma W, \u00c5kerman E, Artigas A, et al. Awake Proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: Guidance from an International group of healthcare workers. Am J Trop Med Hyg 2021;104:1676\u201386.","DOI":"10.4269\/ajtmh.20-1445"},{"key":"23492","unstructured":"Ministry of Health and Family Welfare [Internet]. Resources for COVID-19. COVID-19 proning for self care. Available from: https:\/\/www.mohfw.gov.in\/"},{"key":"23493","doi-asserted-by":"crossref","unstructured":"Kharat A, Simon M, Gu\u00e9rin C. Prone position in COVID 19-associated acute respiratory failure. Curr Opin Crit Care 2022;28:57\u201365.","DOI":"10.1097\/MCC.0000000000000900"},{"key":"23494","doi-asserted-by":"crossref","unstructured":"Fazzini B, Page A, Pearse R, Puthucheary Z. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Br J Anaesth 2022;128:352\u201362.","DOI":"10.1016\/j.bja.2021.09.031"},{"key":"23495","doi-asserted-by":"crossref","unstructured":"Fralick M, Colacci M, Munshi L, et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ 2022;376:e068585.","DOI":"10.1136\/bmj-2021-068585"},{"key":"23496","doi-asserted-by":"crossref","unstructured":"Qian ET, Gatto CL, Amusina O, et al. Assessment of awake prone positioning in hospitalized adults with COVID-19: A nonrandomized controlled trial. JAMA Intern Med 2022;182:612\u201321.","DOI":"10.1001\/jamainternmed.2022.3112"},{"key":"23497","doi-asserted-by":"crossref","unstructured":"Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med 2021;9:1387-95.","DOI":"10.1016\/S2213-2600(21)00356-8"},{"key":"23498","doi-asserted-by":"crossref","unstructured":"Alhazzani W, Parhar KKS, Weatherald J, Al Duhailib Z, Alshahrani M, Al-Fares A, et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure: A randomized clinical trial. JAMA 2022;327:2104\u201313.","DOI":"10.1001\/jama.2022.13994"},{"key":"23499","doi-asserted-by":"crossref","unstructured":"Johnson NJ, Luks AM, Glenny RW. Gas exchange in the prone posture. Respir Care 2017;62:1097-110.","DOI":"10.4187\/respcare.05512"},{"key":"23500","doi-asserted-by":"crossref","unstructured":"Pb S, Mittal S, Madan K, et al. Awake prone positioning in non-intubated patients for the management of hypoxemia in COVID-19: A systematic review and meta-analysis. Monaldi Arch Chest Dis 2021;91:1623.","DOI":"10.4081\/monaldi.2021.1623"},{"key":"23501","doi-asserted-by":"crossref","unstructured":"Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052\u20139.","DOI":"10.1001\/jama.2020.6775"},{"key":"23502","doi-asserted-by":"crossref","unstructured":"Bower G, He H. Protocol for awake prone positioning in COVID-19 patients: to do it earlier, easier, and longer. Crit Care 2020;24:371.","DOI":"10.1186\/s13054-020-03096-x"},{"key":"23503","unstructured":"Ministry of Health and Family Welfare [Internet].| Homepage. Accessed: 2021 Jun 21. Available from: https:\/\/www.mohfw.gov.in\/"},{"key":"23504","doi-asserted-by":"crossref","unstructured":"Jayakumar D, Ramachandran P, Rabindrarajan E, et al. Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection-A multicenter feasibility randomized controlled trial. J Intensive Care Med 2021;36:918-24.","DOI":"10.1177\/08850666211014480"},{"key":"23505","doi-asserted-by":"crossref","unstructured":"Johnson SA, Horton DJ, Fuller MJ, et al. Patient-directed prone positioning in awake patients with COVID-19 requiring hospitalization (PAPR). Ann Am Thorac Soc 2021;18:1424\u20136.","DOI":"10.1513\/AnnalsATS.202011-1466RL"},{"key":"23506","unstructured":"Bamford P, Bentley A, Dean J, Wilson-Baig N. ICS guidance for prone positioning of the conscious COVID patient 2020. Intensive Care Society, UK; 2020. Accessed: August 2020. Available from: https:\/\/emcrit.org\/wp-content\/uploads\/2020\/04\/2020-04-12-Guidance-for-conscious-proning.pdf"},{"key":"23507","doi-asserted-by":"crossref","unstructured":"Coopersmith CM, Antonelli M, Bauer SR, et al. The surviving sepsis campaign: Research priorities for coronavirus disease 2019 in critical illness. Crit Care Med 2021;49:598\u2013622.","DOI":"10.1097\/CCM.0000000000004895"},{"key":"23508","doi-asserted-by":"crossref","unstructured":"Nasa P, Azoulay E, Khanna AK, et al. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 2021;25:106.","DOI":"10.1186\/s13054-021-03491-y"},{"key":"23509","doi-asserted-by":"crossref","unstructured":"Sodhi K, Chanchalani G. Awake proning: Current evidence and practical considerations. Indian J Crit Care Med 2020;24:1236\u201341.","DOI":"10.5005\/jp-journals-10071-23684"},{"key":"23510","doi-asserted-by":"crossref","unstructured":"Koeckerling D, Barker J, Mudalige NL, et al. Awake prone positioning in COVID-19. Thorax 2020;75:833\u20134.","DOI":"10.1136\/thoraxjnl-2020-215133"},{"key":"23511","doi-asserted-by":"crossref","unstructured":"Paul V, Patel S, Royse M, et al. Proning in non-intubated (PINI) in times of COVID-19: Case series and a review. J Intensive Care Med 2020;35:818\u201324.","DOI":"10.1177\/0885066620934801"},{"key":"23512","doi-asserted-by":"crossref","unstructured":"Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, non-intubated patients in the emergency department: A single ED\u2019s experience during the COVID-19 pandemic. Acad Emerg Med 2020;27:375-8.","DOI":"10.1111\/acem.13994"},{"key":"23513","doi-asserted-by":"crossref","unstructured":"Weatherald J, Norrie J, Parhar KKS. Awake prone positioning in COVID-19: is tummy time ready for prime time? Lancet Respir Med 2021;9:1347\u20139.","DOI":"10.1016\/S2213-2600(21)00368-4"},{"key":"23514","doi-asserted-by":"crossref","unstructured":"Taylor SP, Bundy H, Smith WM, et al. Awake prone positioning strategy for nonintubated hypoxic patients with COVID-19: A pilot trial with embedded implementation evaluation. Ann Am Thorac Soc 2021;18:1360\u20138.","DOI":"10.1513\/AnnalsATS.202009-1164OC"},{"key":"23515","doi-asserted-by":"crossref","unstructured":"Bong CL, Brasher C, Chikumba E, et al. The COVID-19 pandemic: Effects on low- and middle-income countries. Anesth Analg 2020;131:86\u201392.","DOI":"10.1213\/ANE.0000000000004846"},{"key":"23516","doi-asserted-by":"crossref","unstructured":"Klaiman T, Silvestri JA, Srinivasan T, et al. Improving prone positioning for severe acute respiratory distress syndrome during the COVID-19 pandemic. An implementation-mapping approach. Ann Am Thorac Soc 2021;18:300\u20137.","DOI":"10.1513\/AnnalsATS.202005-571OC"},{"key":"23517","doi-asserted-by":"crossref","unstructured":"Telias I, Katira BH, Brochard L. Is the prone position helpful during spontaneous breathing in patients with COVID-19? JAMA 2020;323:2265\u20137.","DOI":"10.1001\/jama.2020.8539"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1581","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1576","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1578","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1579","content-type":"application\/msword","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1577","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/download\/2431\/1581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T10:54:24Z","timestamp":1671188064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/index.php\/macd\/article\/view\/2431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,16]]},"references-count":36,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2022.2431","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2022,12,16]]}}}