Prone versus lateral position in acute hypoxemic respiratory failure patients with HFNO therapy: study protocol for a multicentre randomised controlled open-label trial.

Publication date: Nov 27, 2023

High-flow nasal oxygen (HFNO) therapy is a leading treatment technique for acute hypoxemic respiratory failure (AHRF), but its treatment failure rate remains high. The awake prone position (APP) has been proven to increase oxygenation and reduce the endotracheal intubation rate in patients with COVID-19-induced AHRF. However, the APP is poorly tolerated in patients, and its performance in improving prognoses is controversial. The lateral position has a similar mechanism and effect to the prone position, but it is more tolerable than the prone position. Therefore, it is worth exploring whether the lateral position is better for awake patients with AHRF. This is a protocol for a three-arm parallel-group multicentre randomised controlled open-label exploratory trial. A total of 583 patients from two hospitals in Chongqing, China, will be randomised to take the semi-recumbent position, lateral position, or prone position at a ratio of 1:1:1. Patients are all diagnosed with AHRF secondary to non-COVID-19 pneumonia or lung infection and receiving HFNO therapy. The primary outcome is ventilator-free days in 28 days. The secondary outcomes are the 28-day intubation rate, 28-day all-cause mortality, total position change time, the incidence of adverse events, number of hours using HFNO therapy, length of hospital and intensive care unit (ICU) stay, and others. We will conduct subgroup analyses on the arterial partial pressure of oxygen to the fraction of inspiration oxygen (PaO2/FiO2) ratio (> 200 mmHg or ≀ 200 mmHg), time from admission to intervention implementation (

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Concepts Keywords
28days Lateral position
China Prone position
Hypoxemic Protocol
Pneumonia Respiratory failure


Type Source Name
disease MESH acute hypoxemic respiratory failure
disease VO protocol
drug DRUGBANK Oxygen
disease MESH treatment failure
disease MESH COVID-19
drug DRUGBANK Tropicamide
disease MESH pneumonia
disease MESH infection
disease VO time
disease IDO intervention
pathway REACTOME Reproduction
disease MESH lung injury
disease VO URE
disease VO effective
drug DRUGBANK Etoperidone
drug DRUGBANK Ranitidine
disease IDO blood
disease MESH deep venous thrombosis
disease MESH pulmonary embolism
disease MESH pneumothorax
drug DRUGBANK Trestolone
disease MESH posture
disease MESH death
drug DRUGBANK Water

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