Prone position in acute respiratory distress syndrome (ARDS)

Abstract

Objective: To review and discuss the prone position manoeuvre in ARDS as a strategy of lung protection. 

Method: A computerized search in MEDLINE of all publicated articles of prone position in ARDS in children and adults was performed. We analyzed mechanisms of action, indications and timing of use, characteristics of the response, positioning manoeuvres, contraindications and complications.

Results: An increase in the effective transpulmonary pressure, which is believed to be an important mechanism of alveolar recruitment, is one of the most important factors in the improvement of systemic oxygenation. In the paedriatric series about 80% of patients presented a positive response to the prone position with an improvement of oxygenation, occurring early and being sustained with time. We found differences in the timing of initiation of the prone position, as well as its duration and frequency. The evidence suggests that the optimum response is most likely to occur during early ARDS. Major iatrogenic complications are limited.

Conclusions: Prone positioning is a manoeuvre with a biological rational to its use. It is an easy and harmless therapeutic intervention in order top improve systemic oxygenation and a reduction in mechanical ventilation parameters in ARDS patients.