Discussion
death
In this pragmatic RCT of COVID-19 patients requiring supplemental oxygen and hospitalised in medical wards, prone positioning did not significantly reduce the rate of NIV or intubation or death at 28 days as compared to usual care. Secondary analyses showed that the probability of intubation or death was lower in the prone position group, a trend driven by results for patients with mild oxygenation impairment on inclusion (SpOOur findings concerning the global rates of intubation and death of COVID-19 patients initially hospitalised in medical wards are comparable to published results, ranging from 1 to 14% for intubation and 0–13% for death [Our main result contrasts with results of previous studies. First studies of prone position in awake patients with COVID-19 outside the ICU showed that prone positioning was feasible and that a prone position session of 3.5 h may improve oxygenation [More recently, an RCT of 248 patients in medical wards yielded results similar to ours [We found a possible protective effect of prone positioning against the risk of intubation or death in patients with the least oxygenation impairment (initial SpOProne positioning in medical wards with low nurse-to-patient ratio requires more patient efforts than in the ICU. In our French hospital medical wards, nurses often have 12 (between 11 and 16 at night) patients to care for and receive help from one auxiliary nurse. This ratio is far below the nurse-to-patient ratio of 1:4 reported in the recent RCT conducted in medical wards in Canada [Longer durations of daily prone position sessions likely benefit patients [