Prone position in ARDS patients: why, when, how and for whom

In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in...

Full description

Saved in:

Bibliographic Details
Published in:	Intensive care medicine 2020-12, Vol.46 (12), p.2385-2396
Main Authors:	Guérin, Claude, Albert, Richard K., Beitler, Jeremy, Gattinoni, Luciano, Jaber, Samir, Marini, John J., Munshi, Laveena, Papazian, Laurent, Pesenti, Antonio, Vieillard-Baron, Antoine, Mancebo, Jordi
Format:	Article
Language:	eng
Subjects:	Anesthesiology Bedsores COVID-19 Critical Care Medicine Edema Emergency Medicine France Gases Health aspects Humans Intensive Intensive care Life Sciences Lung Compliance - drug effects Lung Compliance - physiology Lungs Medicine Medicine & Public Health Mortality Oxygenation Pain Medicine Patient positioning Pediatrics Perfusion Pneumology/Respiratory System Pressure ulcers Prone position Prone Position - physiology Respiratory distress syndrome Respiratory Distress Syndrome - complications Respiratory Distress Syndrome - physiopathology Respiratory Mechanics - physiology Review Severe acute respiratory syndrome coronavirus 2 Stress concentration United Kingdom Ventilation
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependent lung regions and less cyclical opening and closing in dependent lung regions. The only absolute contraindication for implementing prone position is an unstable spinal fracture. The maneuver to change from supine to prone and vice versa requires a skilled team of 4–5 caregivers. The most frequent adverse events are pressure sores and facial edema. Recently, the use of prone position has been extended to non-intubated spontaneously breathing patients affected with COVID-19 ARDS. The effects of this intervention on outcomes are still uncertain.
ISSN:	0342-4642 1432-1238