Nonintubated COVID-19 Patients Research Articles

Evaluation of the effect of Modafinil in the improvement of the level of consciousness in patients with COVID-19 encephalopathy: A randomized controlled trial.

COVID-19 can lead to encephalopathy and loss of consciousness. This double-blinded randomized clinical trial conducted in Tehran, Iran, aimed to assess the potential effectiveness of modafinil in patients with COVID-19-related encephalopathy. Nineteen non-intubated COVID-19 patients with encephalopathy were randomized into two groups: a treatment group receiving crushed modafinil tablets and a placebo group receiving starch powder. Modafinil was administered at a dose of 100 mg every 2 h, reaching a peak dosage of 400 mg. The level of consciousness was assessed using the Glasgow Coma Score (GCS) at multiple time points on the day of medication administration. The trial was registered under IRCT20170903036041N3 on 23/5/2021. The average age in the modafinil and placebo groups was 75.33 and 70 years, respectively. No significant differences were observed between the two groups in terms of chronic conditions, clinical symptoms, or laboratory data. GCS scores were similar between the groups at baseline (p-value = 0.699). After four doses of modafinil, GCS scores were slightly higher in the treatment group, but this difference was not statistically significant (p-value = 0.581). GCS scores after each round of drug administration didn't significantly differ between the treatment and placebo groups (p-value = 0.908). Modafinil exhibited a slight improvement in the level of consciousness among COVID-19 patients with encephalopathy, although this improvement did not reach statistical significance when compared to the control group. Further research with larger sample sizes and longer treatment durations is recommended to explore modafinil's potential benefits in managing altered consciousness in COVID-19 patients.

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis.

To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome. We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old. We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate. The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

Compliance of Prone Positioning in Non-Intubated COVID-19 Patients.

Compliance of Prone Positioning in Non-Intubated COVID-19 Patients.

Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia.

Right ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events. The aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients. Between February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission). Among 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05-1.18] in the RVD group and 0.88 [0.84-0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03-2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44-5.95], p = 0.003). Right ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.

Effect of Balloon-Blowing Exercise on Oxygen Saturation in COVID-19 Patients.

Background Balloontherapy is an empirical example that patients with respiratory tract diseases can use toimprovetheirdaily care. The diaphragm and ribs are expanded and raised by the intercostal muscles, which are activated during the balloon-blowing exercise. This makes it possible for the lungs to inhale oxygen and exhale carbon dioxide. Therefore, this study aimed to investigate the impact of balloon-blowing exercise on blood oxygen saturation in stable, non-intubated COVID-19 patients. Methodology Considering the guidelines approved by the Ministry of Health and the Government of India, 250 COVID-19 patients with an age group between 20 and 80 years based on the inclusion criteria were taken. After the collection of baseline data consisting of oxygen saturation (SpO2) measured with a portable pulse oximeter, the balloon-blowing exercise with conventional physiotherapy was given for 30 minutes, and clinical data of SpO2 were re-collected. Results The pre- and post-results of balloon blowing exercise, along with conventional physiotherapy in 250 patients, were assessed by measuring SpO2. The results demonstrated that the balloon exercise was found to be effective, as oxygen saturation improved after the application of the balloon exercise. Analysis revealed that pre- and post-values involving 95.685±1.645 and 98.123±1.445, respectively, differed significantly. The results demonstrated that the application of balloon exercise to COVID-19 patients led to a considerable improvement in SpO2. Conclusion The difference between the pre- and post-values of SpO2 was found to be significant, which suggests that balloon exercise is a low-cost physiotherapy strategy that can be utilized to enhance oxygen saturation in COVID-19 patients. This demonstrates that the need for ICU treatment can be lessened, and consequently, the burden on healthcare facilities can be reduced.

Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography.

The goal of this study was to determine whether an awake prone position (aPP) reduces the global inhomogeneity (GI) index of ventilation measured by electrical impedance tomography (EIT) in COVID-19 patients with acute respiratory failure (ARF). This prospective crossover study included COVID-19 patients with COVID-19 and ARF defined by arterial oxygen tension:inspiratory oxygen fraction (P aO2 :F IO2 ) of 100-300 mmHg. After baseline evaluation and 30-min EIT recording in the supine position (SP), patients were randomised into one of two sequences: SP-aPP or aPP-SP. At the end of each 2-h step, oxygenation, respiratory rate, Borg scale and 30-min EIT were recorded. 10 patients were randomised in each group. The GI index did not change in the SP-aPP group (baseline 74±20%, end of SP 78±23% and end of aPP 72±20%, p=0.85) or in the aPP-SP group (baseline 59±14%, end of aPP 59±15% and end of SP 54±13%, p=0.67). In the whole cohort, P aO2 :F IO2 increased from 133±44 mmHg at baseline to 183±66 mmHg in aPP (p=0.003) and decreased to 129±49 mmHg in SP (p=0.03). In spontaneously breathing nonintubated COVID-19 patients with ARF, aPP was not associated with a decrease of lung ventilation inhomogeneity assessed by EIT, despite an improvement in oxygenation.

Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials.

Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74-0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77-1.11; moderate certainty) and did not increase the risk of adverse events. In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.

Spontaneous Pneumothorax Incidence and Clinical Features in Non-Intubated COVID-19 Patients

Spontaneous Pneumothorax Incidence and Clinical Features in Non-Intubated COVID-19 Patients

Knowledge translation tools to guide care of non-intubated patients with acute respiratory illness during the COVID-19 Pandemic and medication

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide. As the number of patients with acute respiratory illness continues to rise, healthcare professionals need to have a thorough understanding of non-intubated care for COVID-19 patients. To provide the best possible care for these patients, it is crucial to have access to knowledge translation tools that can guide clinical decision-making and optimize patient outcomes. This paper will discuss the importance of knowledge translation tools in patient care and medication management for non-intubated COVID-19 patients, with a focus on understanding non-intubated care for COVID-19 patients. Following these principles will minimize the risk of spreading the virus

Knowledge translation tools to guide care of non-intubated patients with acute respiratory illness during the COVID-19 Pandemic and medication

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide. As the number of patients with acute respiratory illness continues to rise, healthcare professionals need to have a thorough understanding of non-intubated care for COVID-19 patients. To provide the best possible care for these patients, it is crucial to have access to knowledge translation tools that can guide clinical decision-making and optimize patient outcomes. This paper will discuss the importance of knowledge translation tools in patient care and medication management for non-intubated COVID-19 patients, with a focus on understanding non-intubated care for COVID-19 patients. Following these principles will minimize the risk of spreading the virus.

Effects of a Chair Positioning Session on Awake Non-Intubated COVID-19 Pneumonia Patients: A Multicenter, Observational, and Pilot Study Using Lung Ultrasound.

Background: LUS is a validated tool for the management of COVID-19 pneumonia. Chair positioning (CP) may have beneficial effects on oxygenation and lung aeration, and may be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation and lung aeration (LA) changes in non-intubated COVID-19 patients. Methods: A retrospective multicenter study was conducted in an ICU. We analyzed data from LUS exams and SpO2:FiO2 performed before/after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation or LA. Results: Thirty-three patients were included in the study; fourteen (44%) were oxygenation non-responders and eighteen (56%) were oxygenation responders, while thirteen (40.6%) and nineteen (59.4%) patients were classified as LA non-responders and responders, respectively. Changes in oxygenation and LA before/after a CP session were not correlated (r = −0.19, p = 0.3, 95% CI: −0.5–0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 (−0.75–3.75) vs. 4 (−1–6), p = 0.41). The LUS score was significantly correlated with SpO2:FiO2 before a CP session (r = 0.37, p = 0.04, 95% CI: 0.03–0.64) but not after (r = 0.17, p = 0.35, 95% CI: −0.19–0.50). Conclusion: A CP session was associated with improved oxygenation and LA in more than half of the non-intubated COVID-19 patients.

P263 Invasive Pulmonary Aspergillosis (IPA) Among Non-Intubated COVID-19 Patients—a New Age Fungal Storm

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM IntroductionCOVID-19 patients are at higher risk for the development of secondary infections, especially fungal due to multiple risk factors associated with COVID illness and its management. COVID-associated pulmonary aspergillosis (CAPA) is a new clinical entity that is contributing to high morbidity and mortality among immunocompetent COVID-19 patients. Lack of adequate published literature, absence of typical host factors, and lack of specific diagnostic criteria and management algorithms add to the difficulty in early diagnosis and treatment initiation. The scant available data is on CAPA among intubated patients, however, there are no data on CAPA in non-intubated COVID-19 patients.ObjectiveThe aim of our study was to assess the occurrence of IPA among non-intubated COVID-19 patients and its correlation with their demographic profile, risk factors, morbidity, and outcome.MethodsThis observational study included 24 non-intubated CAPA patients and 72 controls (1:3 randomly selected age and sex matched) at our hospital between April-June 2021. CAPA cases were defined as per modified-AspICU criteria. Demographic characteristics, risk factors, treatment, factors contributing to morbidity, and outcomes were evaluated. Descriptive statistics were reported as mean ± SD, median, number, and percentages. The proportion of CAPA was reported as frequencies and percentages. Clinical characteristics were compared between CAPA and control using Chi-squared, independent t-test and Mann-Whitney U test as appropriate. Association of CAPA with mortality was performed using Fisher's exact test. Logistic regression was performed to assess the factors associated with CAPA. P-value ˂5% was considered statistically significant. All analyses were performed using SPSS 25.0.ResultsA total of 4058 COVID patients were admitted during the study period. Respiratory samples of 26 patients yielded Aspergillus species. Two patients were excluded as colonizers based on modified AspICU criteria. In all, 24 CAPA cases 72 controls were studied for all the variables. CAPA occurrence was 0.59% among non-intubated COVID-19 patients (24/4058).Both the groups had a male preponderance (75% CAPA, 80% control), the median age was 52.8 ± 14.3. Demographic data and risk factors were comparable. There were no significant differences in lab parameters between the groups. Association of COVID severity and development of CAPA was not statistically significant (mod:OR 2.25, 95% CI, P-value .48; severe:OR 6.65, 95% CI, P-value .08). Significant associations between the cases and controls included, treatment with a higher dose and longer duration of steroids with development of CAPA (dose:OR 1.009, 95% CI, P-value .002; duration:OR 1.09, 95% CI, P-value .006), longer hospital stay (median of 18.4±10days (P-value .008). All-cause mortality was 16.7% in CAPA group (P-value <.0001).Between CAPA non-survivors and survivors, Serum galactomannan levels (P-value .03), duration of hospital stay (P-value .042), dose and duration of systemic corticosteroid (P-value .001), and duration of oxygen requirement (P-value .05) were found to be statistically significant.ConclusionCAPA is an emerging complication with high morbidity and mortality among immunocompetent COVID-19 patients that requires a high index of clinical suspicion. A standard diagnostic criteria and management protocol for early identification and treatment initiation is the need of the hour. Role of steroids in the development of CAPA and the role of galactomannan in diagnosis and prognosis of CAPA needs to be further investigated.

Determinants of Increased Effort of Breathing in Non-Intubated Critical COVID-19 Patients.

Background and objectives: Acute respiratory distress syndrome (ARDS) is the most common complication occurring in COVID-19 patients admitted to the ICU. Given the increased respiratory work of these patients, it is necessary to evaluate their actual breathing efforts. The aim of this study is to report the incidence and determinants of increased effort of breathing (EOB) in critical COVID-19 patients. Materials and Methods: This was a retrospective study of COVID-19 patients admitted to the ICU during the year of 2020. Respiratory rate (RR) was chosen as an indicator of EOB. The cut-off value was set at more than 20 breaths per minute. ROC-AUC analysis was performed to identify the accuracy of the PaO2 and PaCO2 to determine increased EOB. Furthermore, multivariate regression analysis was performed to reveal the determinants of increased EOB. Results: 213 patients were included in the study. Mean RR in the population was 24.20 ± 6.28. 138 (64.8%) of the patients had increased EOB. The ROC-AUC analysis revealed the PaO2 (0.656 (CI 95%: 0.579–0.734, p < 0.001) as more accurate predictor of EOB than PaCO2 (0.584 (CI 95%: 0.505–0.662, p = 0.043). In the final multivariate model, the SpO2 (exp(B) = 0.922, CI 95%: 0.874–0.97 p = 0.033), PaO2/FiO2 ratio (exp(B) = 0.996, CI 95%: 0.922–1.000, p = 0.003) and PaO2 (exp(B) = 0.989 CI 95%: 0.982–0.996 p = 0.003) prevailed as independent predictors of increased EOB. Conclusions: To conclude, PaO2 was revealed as a more accurate predictor of increased EOB than PaCO2. Further investigation revealed the independent determinants of EOB: blood oxygen saturation, PaO2 and PaO2/FiO2 ratio.

Potential of FX06 to prevent disease progression in hospitalized non-intubated COVID-19 patients — the randomized, EU-wide, placebo-controlled, phase II study design of IXION

BackgroundMore than 2.7 million hospitalizations of COVID-19-infected patients have occurred in Europe alone since the outbreak of the coronavirus in 2020. Interventions against SARS-CoV-2 are still in high need to prevent admissions to ICUs worldwide. FX06, a naturally occurring peptide in humans and other mammals, has the potential to reduce capillary leak by improving endothelial dysfunction and thus preventing the deterioration of patients. With IXION, we want to investigate the potential of FX06 to prevent disease progression in hospitalized, non-intubated COVID-19 patients.MethodsIXION is an EU-wide, multicentre, placebo-controlled, double-blinded, parallel, randomized (2:1) phase II clinical study. Patient recruitment will start in September 2022 (to Q2/2023) in Germany, Italy, Lithuania, Spain, Romania, Portugal, and France. A total of 306 hospitalized patients (≥ 18 years and < 75 years) with a positive SARS-CoV-2 PCR test and a COVID-19 severity of 4–6 according to the WHO scale will be enrolled. After randomization to FX06 or placebo, patients will be assessed until day 28 (and followed up until day 60). FX06 (2 × 200 mg per day) or placebo will be administered intravenously for 5 consecutive days. The primary endpoint is to demonstrate a difference in the proportion of patients with progressed/worsened disease state in patients receiving FX06 compared to patients receiving placebo. Secondary endpoints are lung function, oxygen saturation and breathing rate, systemic inflammation, survival, capillary refill time, duration of hospital stay, and drug accountability.DiscussionWith IXION, the multidisciplinary consortium aims to deliver a new therapy in addition to standard care against SARS-CoV-2 for the clinical management of COVID-19 during mild and moderate stages. Potential limitations might refer to a lack of recruiting and drop-out due to various possible protocol violations. While we controlled for drop-outs in the same size estimation, recruitment problems may be subject to external problems difficult to control for.Trial registrationEudraCT 2021-005059-35. Registered on 12 December 2021. Study Code TMP-2204-2021-47.

Self-perceived dysphagia in non-invasively ventilated COVID-19 patients

PurposeCOVID-19 is known to present with a wide range of clinical symptoms. COVID-19-related dysphagia has been frequently investigated in patients who were critically ill and mechanically ventilated, but not in those with less severe presentations. This study aims to identify the frequency, characteristics, and severity of self-perceived oropharyngeal dysphagia in non-intubated COVID-19 patients.MethodsIn this cross-sectional study, data were collected from patients using a self-administered questionnaire that included the Eating Assessment Tool (EAT-10).ResultsThe study included 359 participants with a median age of 34 (range: 18–65) years. Self-perceived dysphagia (EAT-10 total score > 2) was identified in 64.62%, and their median EAT-10 total score was 13 (range 3–40). The most prevalent symptoms were painful swallowing, affected pleasure of eating, stressful swallowing, and coughing while eating. Age, gender, and hospitalization were not statistically significantly associated with the presence of dysphagia, while re-infection, duration, and severity of COVID-19 diagnosis were. The EAT-10 total score was higher in moderate and severe COVID-19 cases as compared to mild cases, and showed a statistically significant inverse correlation with the duration of COVID-19 (r = − 0.267).ConclusionSelf-perceived dysphagia was prevalent in non-intubated COVID-19 patients. Its severity was related to that of COVID-19 and its duration.

An increasing rate of pneumomediastinum in non-intubated COVID-19 patients: The role of steroids and a possible radiological predictor

An increasing rate of pneumomediastinum in non-intubated COVID-19 patients: The role of steroids and a possible radiological predictor

Does awake prone positioning prevent the use of mechanical respiratory support or death in COVID-19 patients on standard oxygen therapy hospitalised in general wards? A multicentre randomised controlled trial: the PROVID-19 protocol

IntroductionCOVID-19 is responsible of severe hypoxaemia and acute respiratory distress syndrome (ARDS). Prone positioning improves oxygenation and survival in sedated mechanically patients with ARDS not related to COVID-19. Awake prone...

Predictors of Treatment Success in Awake Prone Positioning for Non-Intubated COVID-19 Patients With Acute Hypoxemic Respiratory Failure.

Prone positioning is known to reduce mortality among patients on mechanical ventilation with moderate-to-severe ARDS.[1][1] When extrapolating data about these patients with ARDS, awake prone positioning is touted as a low-risk intervention that can be performed outside the ICU. Studies show that

SAFETY AND EFFICACY OF INHALED HIGH-DOSE NITRIC OXIDE IN NON-INTUBATED PATIENTS WITH COVID-19 PNEUMONIA

TYPE: Abstract TOPIC: Chest Infections PURPOSE: There are no proven pharmacologic interventions for COVID-19 that primarily target the respiratory system. This study evaluated the safety and the beneficial effects of high-dose inhaled nitric oxide (NO) in non-intubated patients with COVID-19. METHODS: In this interventional study, NO gas (160 parts-per-million [ppm]) was administered for thirty minutes twice daily in hospitalized, non-intubated COVID-19 patients. RESULTS: Between March and June 2020, twenty-nine COVID-19 patients received a total of 217 inhaled NO treatments. The maximum level of nitrogen dioxide was 1.5 ppm. The peak level of methemoglobin (MetHb) during the treatments was 4.7% and decreased in all patients 5 minutes after NO discontinuation. No adverse events, such as hypoxemia or hypotension, occurred during treatments, and none of the patients experienced acute kidney injury during hospitalization. Breathing NO acutely decreased the respiratory rate of tachypneic patients and improved oxygenation in hypoxemic patients [Figure 1]. One of the 29 patients studied required invasive mechanical ventilation and none of the patients died during the trial. The median hospital length of stay was 6 days [interquartile range 4-8]. Discharged patients did not require hospital readmission and did not develop sequelae of COVID-19 during 28 days of follow-up. CONCLUSIONS: In non-intubated COVID-19 patients, administration of inhaled NO at 160 ppm for 30 minutes twice daily decreased the respiratory rate of tachypneic patients and improved oxygenation in hypoxemic patients without any adverse events. CLINICAL IMPLICATIONS: High-dose NO gas might be a valuable treatment option in non-intubated patients with COVID-19 infection. DISCLOSURE: The study medication was provided free of charge by Praxair Inc and by Airgas Healthcare, an Air Liquide company. The non-invasive co-oximeter was provided by Masimo Corp (the companies did not oversight the study). KEYWORD: Nitric Oxide

Comparison of prone position effectiveness with percentage of injured lung area in awake non - intubated COVID-19 patients

Aim: Prone position plays a key role in the treatment of both non-intubated and intubated patients because COVID-19 associated respiratory failure is gas exchange abnormalities based on shunt and dead-space ventilation. In this study, we aimed to compare the effect of prone position applied in awake non-intubated COVID-19 patients with percentage of injured lung area. &#x0D; Material and Method: 65 patients with awake, non-intubated were included in this prospective, single-center study. Percentage of injured lung area was calculated using chest computer tomography taken during diagnosis of patients. The prone position cycle was applied as 6 hours prone, 4-6 hours supine position. &#x0D; Results: The mean of percentage of injured lung area was 25.16±13.81. When percentage of injured lung area groups were compared with the 0th, 6th, 24th and 48th hour SpO2/FIO2 ratio and respiratory frequency; while the SpO2/FIO2 ratio increased in all hours with prone position in the 0-10% and 10-30% groups, a decrease was observed in the SpO2/FIO2 ratio over time in the ≥ 30% group. &#x0D; Conclusions: The prone position is a safe and effective application that causes improvement in SpO2/FIO2 ratio and RR in awake non-intubated COVID-19 patients with less damage to the lung. However, it should be kept in mind that as the damage to the lung increases, the expected recovery might not be possible.