Douglas et al turned 6 patients in acute respiratory failure from supine to prone and reported a mean increase in Pao2 of 69 mm Hg without changing any mechanical ventilation parameters such as tidal volume, oxygen concentration, or pressures.3 There was increasing interest in the maneuver as well as research in the decades to follow, but the studies failed to demonstrate important patient-focused outcomes such as improved survival4 until the 2013 Proning of Severe ARDS Patients (PROSEVA) controlled trial.5 In this randomized trial, Guerin et al5 employed long durations of prone ventilation (16 hours or more) in patients with moderate to severe ARDS to reduce the 28-day mortality from 32.8% in patients in the supine group to 16.0% in those in the prone group, resulting in a 16% absolute risk reduction in mortality (number needed to treat: 6 to save 1 life).Flipped Physiology Prone positioning has multiple beneficial effects for both ventilation and oxygenation. Adopting a prone position results in more homogeneous ventilation, decreases shunting, and improves ventilation and perfusion matching by offloading abdominal and cardiac weight from the lung tissues and by switching the dependent area of infiltrates away from the posterior lung tissues.6 More homogeneous ventilation is thought to also decrease lung injury by distributing mechanical force from the ventilator across the lung during inhalation more evenly.6 Evidence from small observational and retrospective studies suggests that prone positioning in nonintubated patients is feasible and associated with improved oxygenation.7-14 To date, there are no published randomized controlled trials that definitively demonstrate a mortality benefit of prone over supine positioning for awake and spontaneously breathing patients with COVID-19. The work by Wendt et al1 crosses boundaries between being a retrospective observational study and a report of a quality improvement (QI) project. Because of these blurred boundaries, the authors may have been well served to have used established reporting guidelines such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)19 or Standards for QUality Improvement Reporting Excellence (SQUIRE).20 These reporting guidelines would have ensured that the authors reported in a consistent manner and would have facilitated future comparisons among similar studies. Some studies describe a 1-hour period, repeated 5 times daily,14 whereas others used “as long as tolerated” durations, which resulted in a median duration of 75 minutes (range 30 minutes-480 minutes).13 Contraindications to proning from the literature include clinical or hemodynamic instability and recent thoracic or abdominal surgery.6 Patients with Do Not Resuscitate orders or advanced directives have been excluded from previous research studies on proning, and clinicians should apply proning as individualized comfort or palliative measures indicate for these patients.6 Be aware that cardiac arrests do occur in the prone position, they may be more difficult to detect,23 and they