The SARS-CoV-2 can lead to severe illness with COVID-19 . Outcomes of patients requiring mechanical ventilation are poor . Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited . This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO) ) on a respiratory high-dependency unit (HDU), is associated with improved outcomes . HDU care included awake proning by respiratory physiotherapists . Of 565 patients admitted with COVID-19, 71 (12.6 %) were managed on the respiratory HDU, with 48 of these (67.6 %) requiring respiratory support . Patients managed with CPAP alone 22/48 (45.8 %) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2 %): CPAP mortality 36.4% ; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality . The mortality of patients with COVID-19 requiring respiratory support is considerable . Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful . Further prospective studies are required.