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Contemporary Reviews in Critical Care Medicine |

Treatment of ARDS With Prone Positioning

Eric L. Scholten, MD; Jeremy R. Beitler, MD, MPH; G. Kim Prisk, PhD, DSc; Atul Malhotra, MD
Author and Funding Information

aDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA

bDepartments of Medicine and Radiology, University of California, San Diego, La Jolla, CA

CORRESPONDENCE TO: Eric L. Scholten, MD, Division of Pulmonary and Critical Care Medicine, University of California at San Diego, 9300 Campus Point Dr, Mail Code 7381, La Jolla, CA 92037-7381


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(1):215-224. doi:10.1016/j.chest.2016.06.032
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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.

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