A nonrandomized controlled trial yesterday in JAMA Internal Medicine shows worse outcomes for hospitalized COVID-19 patients with low oxygen levels placed in the prone (chest-down) position while awake, although a commentary cautions about study design shortcomings.

Led by Vanderbilt University researchers, the study assessed the clinical outcomes of 501 COVID-19 patients with hypoxemia (low oxygen levels) not on mechanical ventilation who were placed in the prone position at two academic medical centers from May 13 to Dec 11, 2020.

Patients were assigned in a 1:1 ratio to receive either prone positioning (intervention group) or usual care (control group). Average patient age was 61.0 years, 56.7% were women, and 83.2% were of non-Hispanic races.