[Positioning of patients with acute respiratory failure]

The collapse of lung tissue, edema and intrapulmonary shunt are the main symptoms in patients with acute respiratory insufficiency. The techniques of ventilation in a prone position and continuous lateral rotational therapy (CLRT) are based on these pathophysiological changes. Ventilation in a prone position was found to improve ventilation and perfusion relationships and reduction in the pleural pressure gradient. In hypoxemic lung failure (PaO(2)/FIO(2) <100) a prone position was found to improve oxygenation as a rescue measure and to improve survival. In contrast CLRT is considered to be an early therapeutic or prophylactic measure aimed at prevention of ventilation-associated complications. In trauma patients these beneficial effects were demonstrated in several studies. Positioning therapy can be accompanied by potentially serious complications (e.g. face and skin ulceration, accidental loss of tubes and catheters and cardiac arrhythmias) and its use requires routine management and exact knowledge of indications and risks.