Prone positioning is an established intervention in mechanically ventilated acute respiratory distress syndrome (ARDS) patients, with demonstrated reductions in mortality.

Preliminary data suggest that awake proning in patients with COVID-19 treated with high-flow nasal oxygenation (HFNO) improves gas exchanges, and might be associated with a reduced need of mechanical ventilation, and reduced mortality. Further investigation in a formal randomized-controlled trial is need.

Inclusion Criteria:

• COVID-19, either confirmed by SARS-CoV-2 assay, or clinically suspected, with results of the assay pending;
• Lung infiltrates documented on chest X-ray or chest CT-scan;
• Significant respiratory distress that requires treatment with HFNO.

Exclusion Criteria:

• Unable to consent;
• Unable to prone;
• Indication for immediate endotracheal intubation and mechanical ventilation;
• Contraindication to prone positioning (severe obesity, abdominal wound, pregnancy, unstable pelvic/spinal lesions, vomiting, etc.);
• Comfort care or imminent expectation of death.