Journal Article Review Ahead of print 1 citation
PubMed: 42474726 DOI: 10.1007/s00134-026-08543-x
Prone positioning in ARDS.
Intensive Care Med
Authors: Stephan Ehrmann, Jie Li, Ling Liu, Claude Guérin
Affiliations
- CHRU de Tours, Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TRIGGERSEP F-CRIN Research Network, Tours, France.
- INSERM, Research Center for Respiratory Diseases, U1100, University of Tours, Tours, France.
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, USA.
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
- University of Lyon, Lyon, France.
- Institut Mondor de Recherches Biomédicales, INSERM 955, Créteil, France.
Abstract
Over the past five decades, prone positioning has evolved from single case reports to an evidence-based intervention. Initially used as a rescue therapy, it is now recognized as an integral component of lung-protective mechanical ventilation strategies, applied early in intubated patients with acute respiratory distress syndrome (ARDS) with a PaO 2/F IO 2 ratio < 150 mmHg. The COVID-19 pandemic further expanded its use to non-intubated patients, the so-called awake prone position (APP), with promising results. APP requires confirmation in non-COVID patients and in a more routine ICU practice. Improved oxygenation is a consistent and well-recognized effect of prone positioning in both intubated and non-intubated patients with ARDS. Beyond its effects on gas exchange, prone positioning mitigates ventilator-induced lung injury by reducing lung stress and strain and may also confer favorable hemodynamic effects. This article reviews the physiologic rationale for prone positioning, evidence from randomized controlled trials, current guideline recommendations, practical aspects of implementation, and ongoing questions in both intubated and non-intubated patients.
MeSH
Lung, Stress, Physiological, Critical Care, Intensive Care Units, Prone Position