Efficacy of awake prone positioning for severe illness coronavirus disease 2019 patients: a propensity score‐adjusted cohort study

AIM: Awake prone positioning (PP) in patients with coronavirus disease 2019 (COVID‐19) can improve oxygenation. However, evidence showing that it can prevent intubation is lacking. This study investigated the efficacy of awake PP in patients with COVID‐19 who received remdesivir, dexamethasone, and anticoagulant therapy. METHODS: This was a two‐center cohort study. Patients admitted to the severe COVID‐19 patient unit were included. The primary outcome was the intubation rate and secondary outcome was length of stay in the severe COVID‐19 unit. After propensity score adjustment, we undertook multivariable regression to calculate the estimates of outcomes between patients who received awake PP and those who did not. RESULTS: Overall, 108 patients were included (54 [50.0%] patients each who did and did not undergo awake PP), of whom 25 (23.2%) were intubated (with awake PP, 5 [9.3%] vs. without awake PP, 20 [37.0%]; P < 0.01). The median length of stay in the severe COVID‐19 unit did not significantly differ (with awake PP, 5 days vs. without awake PP, 5.5 days; P = 0.68). After propensity score adjustment, those who received awake PP had a lower intubation rate than those who did not (odds ratio, 0.22; 95% confidence interval, 0.06–0.85; P = 0.03). Length of stay in the severe COVID‐19 patient unit did not differ significantly (adjusted percentage difference, −24.4%; 95% confidence interval, −56.3% to 30.8%; P = 0.32). CONCLUSION: Awake PP could be correlated with intubation rate in patients with COVID‐19 who are receiving remdesivir, dexamethasone, and anticoagulant therapy.