title: Treatment of ARDS With Prone Positioning.
abstract: Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning. By optimizing patient selection and treatment protocols, the recent Proning Severe ARDS Patients (PROSEVA) trial demonstrated a significant mortality benefit with prone ventilation. This trial, and subsequent meta-analyses, support the role of prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early with other lung-protective strategies. This review discusses the physiological principles, clinical evidence, and practical application of prone ventilation in ARDS.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA. Electronic address: escholten@ucsd.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Scholten
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Beitler
authors.affiliation: Departments of Medicine and Radiology, University of California, San Diego, La Jolla, CA.
authors.forename: G Kim
authors.initials: GK
authors.lastname: Prisk
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D006801:Humans; D016684:Prone Position / Q000502:physiology*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy; D015656:Respiratory Mechanics / Q000502:physiology; D016896:Treatment Outcome
keywords: ARDS; critical care; hypoxemia; lung injury; ventilation