Prone to Success: Strategies to Improve Outcomes in Adult Respiratory Failure Patients

Acute hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS) are life-threatening conditions marked by impaired gas exchange due to ventilation-perfusion mismatch and intrapulmonary shunting, often from inflammatory alveolar-capillary injury. Recognizing ARDS and initiating lung-protective strategies, such as low tidal volume ventilation, individualized positive end-expiratory pressure, and prone positioning are crucial. Prone positioning improves oxygenation and outcomes in intubated patients and may benefit select awake patients when used early with close monitoring. Noninvasive support including a high-flow nasal cannula, may be appropriate for selected patients who are prone. Understanding the physiologic underpinnings and applying evidence-based interventions can significantly improve patient outcomes.