ICU · Respiratory / ventilation

Prone Ventilation — Technique & Physiology

Also known as Prone ventilation · Prone positioning · Proning · PROSEVA · Proning technique · Proning team · Proning physiology · Awake proning

Prone ventilation reduces mortality in severe ARDS (PROSEVA, NEJM 2013) by recruiting the dorsal lung, improving ventilation-perfusion matching, and reducing ventilator-induced lung injury through more uniform lung stress and strain — a benefit beyond oxygenation. Physiologically, proning places the heart on the sternum (not the lung) and flattens the pleural-pressure gradient, so the dorsal lung (the larger, healthier region) recruits and the ventral lung is less overdistended. The technique is a coordinated team procedure with a dedicated airway leader, preceded by a checklist (a secured airway, lines managed, eye and pressure-area protection, gastric decompression, adequate sedation), with the patient kept prone for at least 16 hours. The complications — accidental extubation, line loss, and pressure injury — are minimised by a trained team.