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Updated: Jul 31, 2025
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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
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Awake prone positioning in acute hypoxaemic respiratory failure
Bairbre A McNicholas1,2, Miguel Ibarra-Estrada3, Yonatan Perez4,5,6
1Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland.
Summary
Awake prone positioning (APP) improves oxygenation in patients with acute hypoxaemic respiratory failure. This technique benefits hypoxemic patients requiring advanced respiratory support, particularly during COVID-19.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Awake prone positioning (APP) gained attention for COVID-19 patients with acute hypoxemic respiratory failure.
- Previous studies showed APP benefits in influenza and immunocompromised patients.
- APP mimics physiological improvements seen in invasively ventilated ARDS patients.
Approach:
- Review of physiological mechanisms of prone positioning on lung mechanics and gas exchange.
- Summarization of recent evidence on APP, focusing on COVID-19 applications.
- Examination of factors influencing APP success, optimal patient populations, and future research directions.
Key Points:
- APP offers physiological benefits similar to invasive ventilation for acute respiratory distress syndrome.
- Randomized controlled trials in COVID-19 have reported varied outcomes.
- Patients with severe hypoxemia needing advanced respiratory support benefit most from prolonged APP.
Conclusions:
- APP is a valuable non-invasive tool for managing acute hypoxemic respiratory failure.
- Careful patient selection and monitoring are crucial for successful APP implementation.
- Further research is needed to optimize APP protocols and identify ideal patient candidates.
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