A move to endorse prone positioning in nonintubated patients with COVID-19 who require oxygenation has led to international debate in the pages of major respiratory journals.

This follows the UK Intensive Care Society’s April guidance suggesting that prone positioning should be trialled in all suitable conscious patients, as it might reduce the need for mechanical ventilation.  

But adoption of the approach has been questioned by clinicians from Leicester University, UK, and others in a June commentary in Thorax that points to a lack of evidence for the practice.

The Intensive Care Society’s approach has been “extrapolated” to apply to conscious patients based on physiological principles and clinical evidence of a reduction in mortality from a trial in patients with acute respiratory distress syndrome (ARDS) undergoing invasive mechanical ventilation, they write.