Benefits of the prone position in patients with non-intubated COVID-19




Prone Position; Coronavirus Infections; Noninvasive Ventilation; COVID-19.


The aim of the study was to highlight the benefits of the prone position in patients with unintubated COVID-19. This is an integrative literature review, using the keywords "prone position" and "coronavirus" not "respiration, artificial", using the PubMed databases, Google Scholar, the Virtual Health Library (VHL), Latin Literature -American and Caribbean Health Sciences (LILACS). After applying the inclusion and exclusion criteria, the PRISMA flowchart was used to elucidate the selection of articles and a table showing the results that make up the review. The prone position in patients affected by SARS-COV-2 on non-invasive ventilation has mainly brought about a reduction in respiratory effort and it has been reported that it has led to a lower incidence of intubation. Furthermore, it can improve pulmonary homogeneity, pulmonary redistribution, lung compliance, the proportion of recruitment for infiltration and lung recruitment. In conclusion, the prone position provides several benefits for patients not intubated with COVID-19, providing improved saturation and reduced mortality, in addition to preventing intubation.


Araújo, M. S. de, Santos, M. M. P. dos, Silva, C. J. de A., Menezes, R. M. P. de, Feijão, A. R., & Medeiros, S. M. de. (2021). Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review. Revista Latino-Americana de Enfermagem, 29.

Bastoni, D., Poggiali, E., Vercelli, A., Demichele, E., Tinelli, V., Iannicelli, T., & Magnacavallo, A. (2020). Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emerg Med J, 565–566.

Burton-Papp, H. C., Jackson, A. I. R., Beecham, R., Ferrari, M., Nasim-Mohi, M., Grocott, M. P. W., Chambers, R., & Dushianthan, A. (2020). Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre. F1000Research, 9, 859.

Chad, T., & Sampson, C. (2020). Prone positioning in conscious patients on medical wards: A review of the evidence and its relevance to patients with COVID-19 infection. Clinical Medicine, 20(4), e97–e103.

Cohen, D., Wasserstrum, Y., Segev, A., Avaky, C., Negru, L., Turpashvili, N., Anani, S., Zilber, E., Lasman, N., Athamna, A., Segal, O., Shenhav‐Saltzman, G., & Segal, G. (2020). Beneficial effect of awake prone position in hypoxaemic patients with COVID ‐19: case reports and literature review. Internal Medicine Journal, 50(8), 997–1000.

Coppo, A., Bellani, G., Winterton, D., Di Pierro, M., Soria, A., Faverio, P., Cairo, M., Mori, S., Messinesi, G., Contro, E., Bonfanti, P., Benini, A., Valsecchi, M. G., Antolini, L., & Foti, G. (2020). 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. The Lancet Respiratory Medicine, 8(8), 765–774.

Damarla, M., Zaeh, S., Niedermeyer, S., Merck, S., Niranjan-Azadi, A., Broderick, B., & Punjabi, N. (2020). Prone Positioning of Nonintubated Patients with COVID-19. American Journal of Respiratory and Critical Care Medicine, 202(4), 604–606.

Dong, W., Gong, Y., Feng, J., Bai, L., Qing, H., Zhou, P., Du, Y., Zhu, J., & Xu, S. (2020). Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study.

Elharrar, X., Trigui, Y., Dols, A.-M., Touchon, F., Martinez, S., Prud’homme, E., & Papazian, L. (2020). Use of Prone Positioning in Nonintubated Patients With COVID-19 and Hypoxemic Acute Respiratory Failure. JAMA, 323(22), 2336.

Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1), e48.

Ibarra-Estrada, M. Á., Marín-Rosales, M., García-Salcido, R., Aguirre-Díaz, S. A., Vargas-Obieta, A., Chávez-Peña, Q., López-Pulgarín, J. A., Mijangos-Méndez, J. C., & Aguirre-Avalos, G. (2020). Prone positioning in non-intubated patients with COVID-19 associated acute respiratory failure, the PRO-CARF trial: A structured summary of a study protocol for a randomised controlled trial. Trials, 21(1).

Instituto de efectividad clinica y sanitaria, IECS . (2020) . Posicionamento en prono en infección por COVID-19. Documento de Evaluación de Tecnologías Sanitarias - Informe de Respuesta Rápida nº 787 .

Jiang, L. G., LeBaron, J., Bodnar, D., Caputo, N. D., Chang, B. P., Chiricolo, G., Flores, S., Kenny, J., Melville, L., Sayan, O. R., Sharma, M., Shemesh, A., Suh, E., & Farmer, B. (2020). Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID‐19 Patients. Academic Emergency Medicine, 27(7), 566–569.

Moghadam, V. D., Shafiee, H., Ghorbani, M., & Heidarifar, R. (2020). Prone positioning in management of COVID-19 hospitalized patients. Brazilian Journal of Anesthesiology (English Edition), 70(2), 188–190.

Paul, V., Patel, S., Royse, M., Odish, M., Malhotra, A., & Koenig, S. (2020). Proning in Non-Intubated (PINI) in Times of COVID-19: Case Series and a Review. Journal of Intensive Care Medicine, 35(8), 818–824.

Petrone, P., Brathwaite, C. E. M., & Joseph, D. K. (2020). Prone ventilation as treatment of acute respiratory distress syndrome related to COVID-19. European Journal of Trauma and Emergency Surgery.

Raoof, S., Nava, S., Carpati, C., & Hill, N. S. (2019). High-Flow, Noninvasive Ventilation and Awake (Nonintubation) Proning in Patients With Coronavirus Disease 2019 With Respiratory Failure. Chest, 1992–2002.

Sartini, C., Tresoldi, M., Scarpellini, P., Tettamanti, A., Carcò, F., Landoni, G., & Zangrillo, A. (2020). Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA, 2338–2340.

Souza, Marcela Tavares de, Silva, Michelly Dias da, & Carvalho, Rachel de. (2010). Revisão integrativa: o que é e como fazer. Einstein (São Paulo), 8(1), 102-106.

Wendt, C., Mobus, K., Weiner, D., Eskin, B., & Allegra, J. R. (2021). Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress: Single-Site Retrospective Health Records Review. Journal of Emergency Nursing, 47(2), 279-287.e1.

Whittemore, P., Macfarlane, L., Herbert, A., & Farrant, J. (2020). Use of awake proning to avoid invasive ventilation in a patient with severe COVID-19 pneumonitis. BMJ Case Reports, 13(8), e236586.

Winck, J. C., & Ambrosino, N. (2020). COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology, 26(4), 213–220.



How to Cite

BIGARAN, L. T. .; MEIRA, L. D. .; SILVA, J. V. A. da .; GRAÇA RÊGO , V. . .; BARBOSA, T. C. .; PAULA, E. C. de . Benefits of the prone position in patients with non-intubated COVID-19. Research, Society and Development, [S. l.], v. 10, n. 6, p. e38810615910, 2021. DOI: 10.33448/rsd-v10i6.15910. Disponível em: Acesso em: 15 jun. 2021.



Health Sciences