Willemke StilmaEva ÅkermanAntonio ArtigasAndrew BentleyLieuwe D. BosThomas J.C. BosmanHendrik De BruinTobias BrummaierLaura A. Buiteman-KruizingaFrancesco CarcòGregg ChesneyCindy ChuPaul DarkArjen M. DondorpHarm J.H. GijsbersMary Ellen GilderDomenico L. GriecoRebecca InglisJohn G. LaffeyGiovanni LandoniWeihua LuLisa M.N. MaduroRose McGreadyBairbre McNicholasDiego De MendozaLuis Morales-QuinterosFrancois NostenAlfred PapaliGianluca PaternosterFrederique PaulusLuigi PisaniEloi Prud'HommeJean Damien RicardOriol RocaChiara SartiniVittorio ScaravilliMarcus J. SchultzChaisith SivakornPeter E. SpronkJaques SztajnbokYoussef TriguiKathleen M. VollmanMargaretha C.E. Van Der WoudeFacoltà di Medicina e ChirurgiaFaculty of Tropical Medicine, Mahidol UniversityFaculty of Biology, Medicine and HealthUniversité Paris CitéManchester University NHS Foundation TrustCentro de Investigación Biomédica en Red de Enfermedades RespiratoriasOspedale San Carlo, PotenzaGelre ZiekenhuizenFondazione Policlinico Universitario Agostino Gemelli IRCCSInstituto de Infectologia Emilio RibasUniversity Hospital GalwayUniversità Cattolica del Sacro Cuore, Campus di RomaUniversity of OxfordWannan Medical CollegeNYU Grossman School of MedicineIRCCS Ospedale San RaffaeleUniversitat Autònoma de BarcelonaKarolinska UniversitetssjukhusetUniversity of Maryland School of MedicineHospital Universitari Vall d'HebronKarolinska InstitutetHospital Universitari de BellvitgeNuffield Department of MedicineHospital de SabadellNUI GalwayOspedale Maggiore Policlinico MilanoAP-HM Assistance Publique - Hôpitaux de MarseilleThe University of ManchesterHopital Louis-MourierUniversiteit van AmsterdamAmsterdam UMC - University of AmsterdamChiang Mai UniversityReinier de Graaf Hospital - SSDZResearch SectionZuyderland Medisch CentrumAdvancing Nursing LLCCentre Hospitalier d'Aix-en-ProvenceDivision of Pulmonary and Critical Care Medicine2022-08-042022-08-042021-05-05American Journal of Tropical Medicine and Hygiene. Vol.104, No.5 (2021), 1676-168614761645000296372-s2.0-85105548761https://repository.li.mahidol.ac.th/handle/20.500.14594/77288Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. Agrowing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.Mahidol UniversityImmunology and MicrobiologyMedicineArticleSCOPUS10.4269/ajtmh.20-1445