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Contemporary Reviews in Critical Care Medicine |

Treatment of Acute Respiratory Distress Syndrome with Prone Positioning

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

Conflicts of interest: None of the authors listed above have any relevant conflicts of interests (as defined below) to disclose.

Definition from CHEST authors’ instructions online: CHEST asks that authors report any potential conflicts in a three-year period prior to the date of submission and, if known, any upcoming conflicts. Categories to be reported include: royalties or in-kind benefits (eg, travel, accommodations) from a commercial entity, shareholdings, speaker bureau activities, industry advisory committees, expert witness testimony, and litigation related to the subject of the manuscript.

Funding Information: Not applicable

Notation of prior abstract publication/presentation: Not applicable

1Division of Pulmonary & Critical Care Medicine, University of California, San Diego, La Jolla, CA

2Departments of Medicine and Radiology, University of California, San Diego, La Jolla, CA

Corresponding Author Information: Eric L. Scholten MD, UCSD, Division of Pulmonary & Critical Care Medicine, 9300 Campus Point Drive, Mail Code #7381, La Jolla, CA 92037-7381.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.032
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Abstract

Prone positioning was first proposed in the 1970s as a method to improve gas exchange in the acute respiratory distress syndrome (ARDS). Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiology mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proven challenging; several contemporary trials showed no major clinical benefits with proning. By optimizing patient selection and treatment protocols, the most 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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