Prone positioning reduces mortality in the management of intubated patients with moderate-to-severe acute respiratory distress syndrome. It allows improvement in oxygenation by improving ventilation/perfusion ratio mismatching.

Because of its positive physiological effects, prone positioning has also been tested in non-intubated, spontaneously breathing patients, or "awake" prone positioning. This review provides an update on awake prone positioning for hypoxaemic respiratory failure, in both coronavirus disease 2019 (COVID-19) and non-COVID-19 patients. In non-COVID-19 acute respiratory failure, studies are limited to a few small nonrandomised studies and involved patients with different diseases. However, results have been appealing with regard to oxygenation improvement, especially when combined with noninvasive ventilation or high-flow nasal cannula.

The recent COVID-19 pandemic has led to a major increase in hospitalisations for acute respiratory failure. Awake prone positioning has been used with the aim to prevent intensive care unit admission and mechanical ventilation. Prone positioning in conscious, non-intubated COVID-19 patients is used in emergency departments, medical wards and intensive care units.

Several trials reported an improvement in oxygenation and respiratory rate during prone positioning, but impacts on clinical outcomes, particularly on intubation rates and survival, remain unclear. Tolerance of prolonged prone positioning is an issue. Larger controlled, randomised studies are underway to provide results concerning clinical benefit and define optimised prone positioning regimens.

俯卧位可降低中度至重度急性呼吸窘迫综合征插管患者的治疗死亡率。通过改善通气/灌注比失配，可以改善氧合作用。

由于其积极的生理作用，俯卧位也已在非插管，自发呼吸或“清醒”俯卧位的患者中进行了测试。这篇综述提供了2019年冠状病毒病（COVID-19）和非COVID-19患者的低氧血症性呼吸衰竭清醒定位的最新信息。在非COVID-19急性呼吸衰竭中，研究仅限于一些小型的非随机研究，涉及的患者患有不同的疾病。然而，关于氧合改善的结果是吸引人的，特别是与无创通气或高流量鼻插管结合使用时。

最近发生的COVID-19大流行导致急性呼吸衰竭的住院治疗大幅增加。为了防止重症监护病房入院和机械通气，倾向于使用清醒的定位。俯卧位用于有意识的，未插管的COVID-19患者，用于急诊科，病房和重症监护室。

几项试验报告了俯卧时氧合和呼吸频率的改善，但是对临床结果的影响，特别是对插管率和存活率的影响尚不清楚。长时间俯卧位的公差是一个问题。正在进行较大规模的随机对照研究，以提供有关临床获益的结果，并确定优化的俯卧定位方案。