{
  "abstract": "Abstract Objectives To evaluate the effect of lateral versus supine positioning on incidence of hypoxaemia in sedated patients and to provide evidence based recommendations for respiratory strategies.Design Prospective, multicentre, randomised controlled trial.Setting 14 tertiary hospitals in China, July to November 2024.Participants 2159 adults (≥18 years) who underwent sedation.Interventions Sedated patients were randomly assigned (1:1) to receive either lateral positioning or conventional supine positioning, stratified by study centres.Main outcome measures The primary outcome was incidence of hypoxaemia (peripheral oxygen saturation (SpO 2) ≤90%) within the first 10 minutes after positioning. Secondary outcomes included airway rescue interventions, incidence of severe hypoxaemia (SpO2 ≤85%), lowest oxygen saturation recorded, length of stay in the post-anaesthesia care unit, and safety measures (eg, bradycardia, tachycardia, hypotension, new onset arrhythmia). Analyses were performed on an intention-to-treat basis.Results Of 2159 patients randomised, 2143 were included in the primary analysis. The mean age of the patients was 53.1 years, mean body mass index was 23.9, and 53.7% (1150/2143) were women. The incidence of hypoxaemia was significantly lower in the lateral group compared with supine group (5.4% (58/1073) v 15.0% (161/1070); adjusted risk ratio 0.36, 95% confidence interval (CI) 0.27 to 0.49; P<0.001). Compared with patients in the supine group, patients in the lateral group required fewer airway rescue interventions (6.3% (68/1073) v 13.8% (148/1070); adjusted risk ratio 0.46, 0.34 to 0.61; P<0.001), had a lower incidence of severe hypoxaemia (0.7% (8/1073) v 4.8% (51/1070); adjusted risk ratio 0.16, 0.07 to 0.33; P<0.001), and had a higher mean lowest SpO2 level (96.9% v 95.7%, absolute adjusted mean difference 1.20%, 95% CI 0.87% to 1.54%; P<0.001). Additionally, length of stay in the post-anaesthesia care unit was shorter in the lateral group (38.2 v 40.5 minutes; absolute adjusted mean difference −2.22 minutes; 95% CI −3.63 to −0.80; P=0.002). Safety outcomes were comparable between the groups, but tachycardia was less frequent in the lateral group.Conclusions Placing sedated adults in the lateral position significantly reduces the incidence and severity of hypoxaemia and decreases the need for airway rescue interventions without compromising safety. Given its simplicity and low cost, lateral positioning could offer advantages in remote or resource constrained clinical settings. Further replication studies targeting patients with advanced age and high body mass index are needed to improve the generalisability of the findings.Trial registration ClinicalTrials.gov NCT06459167.",
  "authors": [
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China",
        "The Children’s Hospital, School of Medicine, National Clinical Research Centre for Child Health, Zhejiang University, Hangzhou, Zhejiang Province, China"
      ],
      "name": "Hui Ye"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Li-Hua Chu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Guo-Hao Xie"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Ye-Jing Hua"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Yi Lou"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Qiao-Hong Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Zhi-Xin Xu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Meng-Yan Tang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Bing-Duo Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Hui-Yi Hu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Jing Ying"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China",
        "Guizhou Key Laboratory of Anaesthesia and Organ Protection, Zunyi, Guizhou Province, China"
      ],
      "name": "Tian Yu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China",
        "Guizhou Key Laboratory of Anaesthesia and Organ Protection, Zunyi, Guizhou Province, China"
      ],
      "name": "Hai-Ying Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China",
        "Guizhou Key Laboratory of Anaesthesia and Organ Protection, Zunyi, Guizhou Province, China"
      ],
      "name": "Yuan Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Affiliated Jinhua Hospital of Wenzhou Medical University, Jindong District, Jinhua, Zhejiang Province, China"
      ],
      "name": "Zhi-Jian Ye"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Affiliated Jinhua Hospital of Wenzhou Medical University, Jindong District, Jinhua, Zhejiang Province, China"
      ],
      "name": "Xiao-Fang Bao"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Perioperative Medicine, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China"
      ],
      "name": "Ming-Cang Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Perioperative Medicine, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China"
      ],
      "name": "Ling-Yang Chen"
    },
    {
      "affiliations": [
        "Department of Intensive Care Unit, The 903 RD Hospital of PLA, Hangzhou, Zhejiang Province, China"
      ],
      "name": "Xiao-Xia Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The 903 RD Hospital of PLA, Hangzhou, Zhejiang Province, China"
      ],
      "name": "Xing-Bo Zhang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China"
      ],
      "name": "Chang-Shun Huang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China"
      ],
      "name": "Jun Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China"
      ],
      "name": "Ya-Ping Lu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College (Affiliated People’s Hospital), Hangzhou, Zhejiang Province, China"
      ],
      "name": "Fo-Quan Luo"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College (Affiliated People’s Hospital), Hangzhou, Zhejiang Province, China"
      ],
      "name": "Wang Zhou"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui, Zhejiang Province, China"
      ],
      "name": "Chuan-Guang Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui, Zhejiang Province, China"
      ],
      "name": "Hao Cheng"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China"
      ],
      "name": "Wen-Jie Liu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China"
      ],
      "name": "Jie Luo"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Third Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang Province, China"
      ],
      "name": "Yan-Qin Wu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The Third Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang Province, China"
      ],
      "name": "Ru-Ru Li"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Bijie Hospital of Zhejiang Provincial People’s Hospital, Bijie, Guizhou Province, China"
      ],
      "name": "Dong Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Bijie Hospital of Zhejiang Provincial People’s Hospital, Bijie, Guizhou Province, China"
      ],
      "name": "Ling-Qian Hou"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Bijie Hospital of Zhejiang Provincial People’s Hospital, Bijie, Guizhou Province, China"
      ],
      "name": "Lu Shi"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Bijie Hospital of Zhejiang Provincial People’s Hospital, Bijie, Guizhou Province, China"
      ],
      "name": "Jun Zhang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The First Affiliated Hospital of Harbin University, Harbin, Heilongjiang Province, China"
      ],
      "name": "Kun Wang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, The First Affiliated Hospital of Harbin University, Harbin, Heilongjiang Province, China"
      ],
      "name": "Xin Pi"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Guangxing Hospital Affiliated to Zhejiang Chinese Medicine University, Hangzhou, Zhejiang Province, China"
      ],
      "name": "Rong Zhou"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Guangxing Hospital Affiliated to Zhejiang Chinese Medicine University, Hangzhou, Zhejiang Province, China"
      ],
      "name": "Qin-Qin Yang"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Pei-Ling Wan"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Hui Li"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Shui-Jing Wu"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Sheng-Wen Song"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Ping Cui"
    },
    {
      "affiliations": [
        "Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA"
      ],
      "name": "Liqi Shu"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Southampton, Southampton, UK"
      ],
      "name": "Nazrul Islam"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Care, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 311121, China"
      ],
      "name": "Xiang-Ming Fang"
    }
  ],
  "title": "Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial",
  "uid": "fc5c4ef7-ff90-53c2-aebb-9742ddc864ad"
}