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Updated: Jun 17, 2026

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Should prone positioning be routinely used for lung protection during mechanical ventilation?
Henry E Fessler1, Daniel S Talmor
1Department of Pulmonary and Critical Care, John Hopkins School of Medicine, Baltimore, Maryland 212187, USA. hfessler@jhmi.edu
Prone positioning improves oxygenation in acute lung injury and acute respiratory distress syndrome (ARDS) patients. Despite benefits, clinical outcome improvements are inconsistent, positioning it as a rescue therapy.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
Background:
- Prone positioning is a recognized method for enhancing oxygenation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).
- Its efficacy stems from improved pleural-pressure gradients, reduced cardiac compression of the lungs, and better ventilation-perfusion matching.
Purpose of the Study:
- To evaluate the effectiveness of prone positioning as a lung-protective ventilation strategy in ARDS.
- To assess its impact on clinical outcomes beyond gas exchange.
Main Methods:
- Review of randomized trials investigating prone positioning in ARDS patients.
- Analysis of studies focusing on oxygenation and clinical outcomes.
Main Results:
- Prone positioning consistently improves oxygenation in ARDS patients.
- Several randomized trials failed to demonstrate significant improvements in clinical outcomes.
- These trials often faced design limitations or early termination.
Conclusions:
- Prone positioning is an effective intervention for improving oxygenation in severe hypoxemia.
- Its role in improving overall clinical outcomes in ARDS remains inconclusive.
- It is currently considered a rescue therapy for ALI and ARDS.
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