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We've got supine positioning and prone positioning... what about something in-between? Ye et al studied 2,159 patients coming out of anesthesia in a PACU after extubation. As sedation wore off, they placed one group in lateral decubitus, and left the other group supine. The lateral decubitus group had less hypoxia, a higher lowest SpO2, and required fewer airway rescue maneuvers.
Of note, the investigators didn't compare lateral or supine to prone positioning, which is often felt to be the best position for oxygenation (depending on patient characteristics and pathophysiology). And of course, this study represents a very specific scenario quite different from the ED (PACU patients post-extubation), so it's not clear how broadly extrapolatable this is. But this does add to the argument that supine is a poor position for oxygenating patients.
Bottom Line: If your supine patient is oxygenating marginally and you want a small bump without going all the way to prone positioning, consider lateral positioning. May make the most sense for procedural sedation and post-extubation patients in terms of similarity to this particular study.
References
Ye H, Chu LH, Xie GH, Hua YJ, Lou Y, Wang QH, Xu ZX, Tang MY, Wang BD, Hu HY, Ying J, Yu T, Wang HY, Wang Y, Ye ZJ, Bao XF, Wang MC, Chen LY, Wang XX, Zhang XB, Huang CS, Wang J, Lu YP, Luo FQ, Zhou W, Wang CG, Cheng H, Liu WJ, Luo J, Wu YQ, Li RR, Wang D, Hou LQ, Shi L, Zhang J, Wang K, Pi X, Zhou R, Yang QQ, Wan PL, Li H, Wu SJ, Song SW, Cui P, Shu L, Islam N, Fang XM. Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial. BMJ. 2025 Aug 19;390:e084539. doi: 10.1136/bmj-2025-084539. PMID: 40829895; PMCID: PMC12362200.