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Chest
. 2022 Sep 23;S0012-3692(22)03888-0.
doi: 10.1016/j.chest.2022.09.020. Online ahead of print.
"Prone Positioning for Acute Hypoxemic Respiratory Failure and ARDS, a Review"
Garrett L Rampon 1 , Steven Q Simpson 2 , Ritwick Agrawal 3
Affiliations
- PMID: 36162482
- DOI: 10.1016/j.chest.2022.09.020
Abstract
Prone positioning is an immediately accessible, readily implementable intervention that was initially proposed as a method for improvement in gas exchange over 50 years ago. Initially implemented clinically as an empiric therapy for refractory hypoxemia, multiple clinical trials were performed on the use of prone positioning in various respiratory conditions, cumulating in the landmark PROSEVA trial which demonstrated mortality benefit in patients with severe acute respiratory distress syndrome (ARDS). Following this trial and the corresponding meta-analysis, expert consensus and societal guidelines recommended the use of prone positioning for the management of severe ARDS. The ongoing coronavirus disease 2019 (COVID-19) pandemic has brought prone positioning to the forefront of medicine, including widespread implementation of prone positioning in awake, spontaneously breathing, non-intubated patients with acute hypoxemic respiratory failure. Multiple clinical trials have now been performed to investigate the safety and effectiveness of prone positioning in these patients and have enhanced our understanding of the effects of the prone position in respiratory failure. In this review, we discuss the physiology, clinical outcome data, practical considerations, and lingering questions of prone positioning.
Keywords: COVID-19; Prone position; acute respiratory distress syndrome; hypoxemia.