Prone Position as Intervention in Improving Oxygenation Status among Covid 19 Patients : An Integrative Review


  • Ni Kadek Diah Purnamayanti Sekolah Tinggi Ilmu Kesehatan Buleleng
  • Gusti Ayu Kade Ari Suwintari
  • Made Sundayana


Covid 19, prone position, hypoxia, oxygen level


Happy hypoxia is a major issue among Covid 19 patient. Prone position unsurely suggested intervention to boost the oxygen level. This integrative literture review aimed to describe the use of prone position improving oxygen level among Covid 19 patient. Keywords used during the online searching were Covid 19 and prone position and hypoxia. Inclussion criteria was only included original paper published in Bahasa Indonesia and English during 2020. Gray literature such as proceeding and unpublished thesis will be excluded. Critical appraisal tool using Olsen Baigh Scoring. There were three search enggine has been used Google Schoolar, Pubmed, ScienceDirect. Based on our finding there are 14 articles as final result. There are 57,14% (n=8) studies applied awake prone postion with oxygen therapy. Prone position also applied on intubated critically ill patient with supported device. Application of prone position in well alert patient might be modified based on patient tolerance. Outome of oxygen status were determine in blood gas analysis (BGA) result, oxygen saturation, Sequential Organ Failure Assesment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE) score. Prone position is feasible applied as supportive treatment among covid 19 patient with our without ventilator. This intervention potentially improves oxygen saturation but do not decreased risk of mortality.


Alseoudy, M. M., Abo Elfetoh, M. A., & Alrefaey, A. K. (2020). Awake proning of a 2‐year‐old extubated child with severe COVID‐19 pneumonitis. Anaesthesia Reports, 8(2), 180–183.

Astua, A., Michaels, E., & Michaels, A. (2020). Proning During Pandemic: The Rapid Institution of a Safe, Transferable, and Effective Prone Positioning Program at Nychhc/elmhurst Hospital, A Situationally Resource Limited Facility, During the Peak of the Covid 19 Surge. 1–16.

Bamford, A. P., Bentley, A., & Dean, J. (2020). ICS Guidance for Prone Positioning of the Conscious COVID Patient 2020. Intensive Care Society.

Bastoni, D., Poggiali, E., Vercelli, A., Demichele, E., Tinelli, V., Iannicelli, T., & Magnacavallo, A. (2020). Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emergency Medicine Journal, 37(9), 565–566.

Bower, G., & He, H. (2020). Protocol for awake prone positioning in COVID-19 patients: To do it earlier, easier, and longer. Critical Care, 24(1), 20–22.

Cruz Salcedo, E. M., Rodriguez, L.-M., Patel, J., & Seevaratnam, A. R. (2020). Use of Dexmedetomidine in Early Prone Positioning Combined With High-Flow Nasal Cannula and Non-Invasive Positive Pressure Ventilation in a COVID-19 Positive Patient. Cureus, 12(9), 9–13.

Dhont, S., Derom, E., Van Braeckel, E., Depuydt, P., & Lambrecht, B. N. (2020). The pathophysiology of “happy” hypoxemia in COVID-19. Respiratory Research, 21(1), 1–9.

Dubosh, N. M. (2020). Early, awake proning in emergency department patients with COVID-19. The American Journal of Emergency Medicine.

Elkattawy, S., & Noori, M. (2020). A case of improved oxygenation in SARS-CoV-2 positive patient on nasal cannula undergoing prone positioning. Respiratory Medicine Case Reports, 30(May), 101070.

Ferrando, C., Mellado-Artigas, R., Gea, A., Arruti, E., Aldecoa, C., Adalia, R., Ramasco, F., Monedero, P., Maseda, E., Tamayo, G., Hernández-Sanz, M. L., Mercadal, J., Martín-Grande, A., Kacmarek, R. M., Villar, J., & Suárez-Sipmann, F. (2020). Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: A multicenter, adjusted cohort study. Critical Care, 24(1), 1–11.

Fowler, Z., Moeller, E., Roa, L., Castañeda-Alcántara, I. D., Uribe-Leitz, T., Meara, J. G., & Cervantes-Trejo, A. (2020). Projected impact of COVID-19 mitigation strategies on hospital services in the Mexico City Metropolitan Area. PLoS ONE, 15(11 November), 1–14.

Jacobson, J., Antony, K., Beninati, M., Alward, W., & Hoppe, K. K. (2021). Use of dexamethasone, remdesivir, convalescent plasma and prone positioning in the treatment of severe COVID-19 infection in pregnancy: A case report. Case Reports in Women’s Health, 29, e00273.

Jagan, N., Morrow, L. E., Walters, R. W., Klein, L. P., Wallen, T. J., Chung, J., & Plambeck, R. W. (2020). The POSITIONED Study: Prone Positioning in Nonventilated Coronavirus Disease 2019 Patients—A Retrospective Analysis. Critical Care Explorations, 2(10), e0229.

Jiang, L. G., LeBaron, J., Bodnar, D., Caputo, N. D., Chang, B. P., Chiricolo, G., Flores, S., Kenny, J., Melville, L., Sayan, O. R., Sharma, M., Shemesh, A., Suh, E., & Farmer, B. (2020). Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID-19 Patients. Academic Emergency Medicine, 27(7), 566–569.

Koeckerling, D., Barker, J., Mudalige, N. L., Oyefeso, O., Pan, D., Pareek, M., Thompson, J. P., & Andre Ng, G. (2020). Awake prone positioning in COVID-19. Thorax, 75(10), 833–834.

Lindahl, S. G. E. (2020). Using the prone position could help to combat the development of fast hypoxia in some patients with COVID-19. May, 1–6.

Murray, C. J. (2020). Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator-days and deaths by US state in the next 4 months. 114.

Olsen, J. (2014). An integrative review of information systems and terminologies used in local health departments. J Am Med Inform Assoc.

Paul, V., Patel, S., Royse, M., Odish, M., Koenig, S., Hospital, C. F., Hospital, C. F., Diego, S., & Einstein, A. (2020). HHS Public Access. 35(8), 818–824.

Shang, Y., Pan, C., Yang, X., Zhong, M., Shang, X., Wu, Z., Yu, Z., Zhang, W., Zhong, Q., Zheng, X., Sang, L., Jiang, L., Zhang, J., Xiong, W., Liu, J., & Chen, D. (2020). Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Annals of Intensive Care, 10(1), 1–24.

Solverson, K., Weatherald, J., & Parhar, K. K. S. (2020). Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Canadian Journal of Anesthesia.

Souza, M. T. de, Silva, M. D. da, & Carvalho, R. de. (2010). Integrative review: what is it? How to do it? Einstein (São Paulo), 8(1), 102–106.

Venus, K., Munshi, L., & Fralick, M. (2020). Prone positioning for patients with hypoxic respiratory failure related to COVID-19. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 192(47), E1532–E1537.
Whittemore, P., Macfarlane, L., Herbert, A., & Farrant, J. (2020). Use of awake proning to avoid invasive ventilation in a patient with severe COVID-19 pneumonitis. BMJ Case Reports, 13(8), 1–2.

WHO. (2013). Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do. Who, 211kb, 1–12.

Winearls, S., Swingwood, E. L., Hardaker, C. L., Smith, A. M., Easton, F. M., Millington, K. J., Hall, R. S., Smith, A., & Curtis, K. J. (2020). Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: A retrospective analysis. BMJ Open Respiratory Research, 7(1), 1–4.

Wordmeter. (2021). Corona Virus Pandemic.






Research Articles