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Prone Positioning in ARDS

Gordon, Ayla MD; Rabold, Erica MD; Thirumala, Raghukumar MD; Husain, Ahmad Alhaj MD; Patel, Samir MD; Cheema, Tariq MD

doi: 10.1097/CNQ.0000000000000277
Original Articles

Adult respiratory distress syndrome (ARDS) is a clinical entity characterized by hypoxemic respiratory failure in the setting of noncardiogenic pulmonary edema. It is associated with significant morbidity and mortality. Prone positioning is a beneficial strategy in patients with severe ARDS because it improves alveolar recruitment, ventilation/perfusion (V/Q) ratio, and decreases lung strain. The outcome is improved oxygenation, decreased severity of lung injury, and, subsequently, mortality benefit. In this article, we discuss the physiology of prone positioning on chest mechanics and V/Q ratio, the placement and maintenance of patients in the prone position with use of a prone bed and the current literature regarding benefits of prone positioning in patients with ARDS.

Division of Pulmonary-Critical Care (Drs Gordon, Rabold, Thirumala, Husain, and Cheema) and Internal Medicine Residency, Department of Medicine (Dr Patel), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania.

Correspondence: Ayla Gordon, MD, Division of Pulmonary Critical Care, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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