{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T22:32:42Z","timestamp":1784068362521,"version":"3.55.0"},"reference-count":0,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"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":[],"published-print":{"date-parts":[[2021,5,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6\u201312 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.<\/jats:p>","DOI":"10.4269\/ajtmh.20-1445","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T13:53:20Z","timestamp":1615470800000},"page":"1676-1686","source":"Crossref","is-referenced-by-count":25,"title":["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"],"prefix":"10.4269","volume":"104","author":[{"given":"Willemke","family":"Stilma","sequence":"first","affiliation":[{"name":"1Department of Intensive Care, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"},{"name":"2Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"\u00c5kerman","sequence":"additional","affiliation":[{"name":"3Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden;"},{"name":"4Function of Perioperative Medicine and Intensive Care, Department of Intensive Care, Karolinska University Hospital, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Artigas","sequence":"additional","affiliation":[{"name":"5Department of Intensive Care, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain;"},{"name":"6Autonomous University of Barcelona, Sabadell, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bentley","sequence":"additional","affiliation":[{"name":"7Acute Intensive Care Unit, Manchester University NHS Foundation, Manchester, United Kingdom;"},{"name":"8Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieuwe D.","family":"Bos","sequence":"additional","affiliation":[{"name":"1Department of Intensive Care, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J. C.","family":"Bosman","sequence":"additional","affiliation":[{"name":"1Department of Intensive Care, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"de Bruin","sequence":"additional","affiliation":[{"name":"1Department of Intensive Care, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Brummaier","sequence":"additional","affiliation":[{"name":"9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;"},{"name":"10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Buiteman-Kruizinga","sequence":"additional","affiliation":[{"name":"1Department of Intensive Care, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"},{"name":"11Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Carc\u00f2","sequence":"additional","affiliation":[{"name":"12Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg","family":"Chesney","sequence":"additional","affiliation":[{"name":"13Division of Emergency Medicine-Critical Care, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Chu","sequence":"additional","affiliation":[{"name":"9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;"},{"name":"10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Dark","sequence":"additional","affiliation":[{"name":"14Critical Care Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom;"},{"name":"15Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom;"},{"name":"16Humanitarian and Conflict Response Institute, University of Manchester, Manchester, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjen M.","family":"Dondorp","sequence":"additional","affiliation":[{"name":"10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;"},{"name":"17Faculty of Tropical Medicine, Mahidol\u2013Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm J. H.","family":"Gijsbers","sequence":"additional","affiliation":[{"name":"18Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location \u2018AMC\u2019, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ellen","family":"Gilder","sequence":"additional","affiliation":[{"name":"19Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico L.","family":"Grieco","sequence":"additional","affiliation":[{"name":"20Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. 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