All ETDs from UAB

Advisory Committee Chair

Gerald McGwin

Advisory Committee Members

Mark T Dransfield

Michael C Kurz

Document Type


Date of Award


Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health


ationale: Prone positioning is one of the few interventions shown in a robust, randomized, controlled clinical trial to reduce mortality in severe ARDS. Ideal duration of prone positioning is unknown. A 16-hour prone positioning period has been studied and is considered standard, although longer duration may be beneficial. Objectives: Determine if a prolonged prone positioning strategy for patients with COVID-19-induced ARDS is feasible and safe. Methods: We performed a pilot, randomized, parallel-arm feasibility study in patients with COVID-19-induced ARDS. Patients were randomized to either a prolonged 24-hour or a traditional 16-hour prone positioning strategy. Measurements & Main Results: 52 patients were randomized to receive either traditional or prolonged proning. At 96 hours, patients randomized to receive prolonged prone positioning had a higher total duration of time proned (56.6 vs. 45.7 hours, p=0.017), longer mean duration of prone session (23.1 vs. 14.9 hours; p<0.001) and experienced fewer turns (4.6 vs. 5.7 turns, p=0.033). There were no significant differences in central venous catheter, arterial line, or endotracheal tube dislodgements, use of rescue pulmonary vasodilators or pressure ulcer development. Pulmonary mechanics, SpO2:FiO2 ratios, mortality and ventilator-free, ICU-free and hospital-free days were similar between groups. iii Conclusions: Prolonged prone positioning is feasible and safe in comparison to traditional proning. Further study is needed to determine if a prolonged prone positioning strategy is superior to traditional 16-hour prone positioning strategy.

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