Awake prone positioning effectiveness in moderate to severe COVID-19 a randomized controlled trial.

Objectives: We evaluated the efficacy and acceptability of awake-prone positioning (APP) in a randomised controlled trial, using a dedicated APP implementation team and wearable continuous-monitoring devices to monitor position and oximetry. Methods: The trial was performed at a tertiary level hospital in Ho Chi Minh City, Vietnam, recruiting adults (≥18 years) hospitalised with moderate or severe COVID-19 and receiving supplemental oxygen therapy via nasal/facemask systems or high-flow nasal canulae. Participants were randomized (1:1) to standard care or APP. The primary outcome was escalation of respiratory support within 28 days of randomisation. Results: Ninety-three patients were enrolled between March 2022 and March 2023; 80 (86%) had received ≥2 doses of SARS-CoV2 vaccine. Significantly greater mean daily APP times were achieved in those allocated to APP, although most did not achieve the target 8 hours/day. We did not detect significant differences in the primary outcome (RR 0.85, 95% CI 0.40-1.78, p=0.67) or secondary outcomes, including intubation rate and 28-day mortality. Particpants reported prone positioning was comfortable, although almost all preferred supine positioning. No adverse events associated with the intervention were reported. Conclusions: APP was not associated with benefit, but was safe. Continuous monitoring with wearable devices was feasible and acceptable to patients.