Journal
INTENSIVE CARE MEDICINE
Volume 40, Issue 11, Pages 1634-1642Publisher
SPRINGER
DOI: 10.1007/s00134-014-3500-8
Keywords
Acute respiratory distress syndrome (ARDS); Prone position; Mechanical ventilation; Ventilator-induced lung injury
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Prone positioning has been used for many years in patients with acute respiratory distress syndrome (ARDS). The initial reason for prone positioning in ARDS patients was improvement in oxygenation. It was later shown that mechanical ventilation in the prone position can be less injurious to the lung and hence the primary reason to use prone positioning is prevention of ventilator-induced lung injury (VILI). A large body of physiologic benefits of prone positioning in ARDS patients accumulated but these failed to translate into clinical benefits. More recently, meta-analyses and randomized controlled trial in a specific subgroup of ARDS patients demonstrated that prone positioning can improve survival. This review covers the effects of prone positioning on oxygenation, respiratory mechanics, and VILI. We conclude with the effects of prone positioning on patient outcome, in particular on survival.
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