Hypoxia from vasculitic pulmonary haemorrhage improved by prone position ventilation

Ventilation in the prone position is used in patients with acute respiratory distress syndrome (ARDS), although data supporting this strategy are limited, and benefit for patients with other conditions is unclear. The patient in this report had severe hypoxaemia from diffuse alveolar haemorrhage caused by vasculitis with positive antineutrophil cytoplasmic antibodies (ANCA). Ventilation in the prone position improved oxygenation dramatically. This improvement was initially maintained when returned supine, accompanied by increased ventilation. Prone ventilation was used on three consecutive days for 10, 14 and 15 h, respectively. Prone ventilation could improve oxygenation by better ventilation-perfusion (V/Q) matching and improved drainage of blood from the dorsal lung. The improved oxygenation in this patient should encourage the use of prone ventilation in other patients with pulmonary haemorrhage and severe hypoxia.