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Abstract Objectives Our aim is to investigate the effects of a innovative modular prone positioning tools on patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 during awake prone positioning (AW-PP). Methods This prospective randomized controlled study initially enrolled 168 patients with COVID-19 due to ARDS. However, 92 were subsequently disqualified, leaving 76 patients who were randomly assigned to either the observation group (n = 38) or the control group (n = 38). The observation group utilized innovative modular prone positioning tools for non-invasive respiratory support (NIRS), while the control group used soft pillows for the same treatment. Data were collected on comfort levels, adverse events, and efficacy indicators. Additionally, the comfort, incidence of adverse events, and treatment efficacy in both groups were evaluated. Results The observation group had shorter the daily duration spent on executing the AW-PP (2.74 ± 0.86 min vs. 4.64 ± 1.02 min, P 0.05). However, the observation group experienced significantly fewer adverse events, including kinking NIRS circuit, pain, shortness of breath, dizziness, and pressure ulcers (P