ICU SAQs · ARDS & lung protection
Prone positioning in severe ARDS
A core Second-Part question on prone positioning — the multiple physiological mechanisms by which it helps, the PROSEVA mortality evidence (confined to severe disease, requiring at least 16 hours per day), the practical conduct, and the complications a trained team must manage.
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Prompt
A 48-year-old man is on day 2 of mechanical ventilation for severe ARDS from bacterial pneumonia. His PaO2/FiO2 ratio is 78 mmHg on FiO2 0.9 and PEEP 14 cmH2O, with lung-protective settings. Outline the rationale, evidence, technique and complications of prone positioning in this patient.
Question
A 48-year-old man is on day 2 of mechanical ventilation for severe ARDS from bacterial pneumonia. His PaO2/FiO2 ratio is 78 mmHg on FiO2 0.9 and PEEP 14 cmH2O, with lung-protective settings. Outline the rationale, evidence, technique and complications of prone positioning in this patient.
[1]References4ShowHide
- [1]Guérin C, Reignier J, Richard JC, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2013.PMID 23688302
- [2]Bersten AD, Soni N (eds). Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL. The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.
- [4]González-Seguel F, Pinto-Concha JJ, Aranis N, et al. Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS. Respir Care, 2021.PMID 34301802