Background Prone Positioning (PP) is a non-pharmacological treatment used during inva-sive mechanical ventilation (IMV) for severe Acute Respiratory Distress Syndrome (ARDS) During PP, patients lay on their stomach rather than their back, improving the redistribution of lung density from dorsal to ventral areas, gas exchange, and reducing mortality Prone positioning has received significant attention during the current COVID-19 pandemic due to the possibility of avoiding intubation and reducing the pressure on hospital critical care resources We aim to conduct a mini-review to highlight the effect of awake PP during High Flow Nasal Therapy (HFNT) or Noninvasive Ventilation (NIV) on PaO2/FiO2 (P/F) improvements and the need for intubation in patients with mild-to-moderate ARDS Methods We conducted a literature search in November 2020 with no restrictions on the publication date Literature sources included: MEDLINE (Ovid), PubMed, Cochrane Library, LitCOVID, WHO COVID-19 Research Database, BMJ Best Practice, and Google Scholar Eight papers fulfilled the inclusion criteria and were included for the final analysis Results Four of the eight included studies analyzed patients with confirmed SARS-CoV-2 infec-tion Prone positioning maneuvers during HFNT or NIV significantly increased P/F and avoided in-tubation in the majority of patients In most severe ARDS (P/F &lt; 100), PP was insufficient to stabi-lize gas exchange In this sub-group of patients, the rate of progression to mechanical ventilation was sensibly higher PP was generally well tolerated across a wide range of maneuvers duration Conclusion PP during HFNT or NIV could be a viable option in case of mild-to-moderate ARDS both in patients with and without COVID-19 infection Further prospective studies (e g , Randomized-Control Trials) with a larger cohort of patients are needed
Prone positioning and noninvasive respiratory supports in acute hypoxemic respiratory failure