Background: Prone position (PP) has been commonly used in acute respiratory distress syndrome. Awake PP may improve clinical outcomes in COVID-19 patients with acute hypoxemic respiratory failure (AHRF). Aim: To describe awake PP practices and outcomes in COVID-19 patients admitted in intensive care unit (ICU). Methods: A retrospective observational study performed in a 9-bed medical ICU at a teaching hospital between September 19th, 2020, and December 31st, 2021. All adult patients admitted in ICU for AHRF secondary to Covid-19 with a Pao2/Fio2 ?300 mmHg, non-invasively ventilated (high flow nasal cannula (HFNC) OR noninvasive ventilation) and performed awake PP were included. Demographic and clinical characteristics, severity and diagnosis at admission, ICU course and outcomes were collected. Results: During the study period, 172 patients were admitted and 163 (94.7%) were non-invasively ventilated at admission. Among them 124 (76.1%) patients performed awake PP and 39 (23.9%) patients refused or PP was impossible. Patients? characteristics were mean age, 50.84±11.8 years; male, in 76(61.3%); 54(43.5%) had at least one comorbidity; median SAPS II, 23[18-27]; 81(65.3%) had severe lesions at the chest CT scan and HFNC use, 109 (87.9%). The median spo2 was 93[88-97] and median Pao2/Fio2 ratio was 92.5[69-132]. The PP was performed in a median day duration at 6[3-9] days, median sessions per day at 3[2-3] with a median hours? number per day at 12 [8-14]. No complications were observed during the awake PP. The median ICU length of stay, 9[6-14] days and mortality rate were 34.7% due to AHRF. Conclusion: The awake PP was a simple and safe tool for the management of severe AHRF in COVID-19 patients.