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Review
. 2023 Jul 5;27(1):264.
doi: 10.1186/s13054-023-04526-2.

Extended prone positioning for intubated ARDS: a review

Thaïs Walter  1 , Jean-Damien Ricard  2   3
Affiliations
Review

Extended prone positioning for intubated ARDS: a review

Thaïs Walter et al. Crit Care. .

Abstract

During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizational reasons relying on a predetermined fixed duration. A recent study argued that a clinically driven extension of prone positioning beyond 24 h could be associated with reduced mortality. On a patient level, the main benefit of extending prone positioning beyond 24 h is to maintain a more homogenous distribution of the gas-tissue ratio, thus delaying the increase in overdistention observed when patients are returned to the supine position. On an organizational level, extending prone positioning reduces the workload for both doctors and nurses, which might significantly enhance the quality of care in an epidemic. It might also reduce the incidence of accidental catheter and tracheal tube removal, thereby convincing intensive care units with low incidence of ARDS to prone patients more systematically. The main risk associated with extended prone positioning is an increased incidence of pressure injuries. Up until now, retrospective studies are reassuring, but prospective evaluation is needed.

Keywords: Acute respiratory distress syndrome; Extended prone positioning; Mechanical ventilation; Prolonged prone positioning; Prone positioning.

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Conflict of interest statement

Jean-Damien Ricard: Fisher&Paykel covered travel expenses and provide high flow devices to a multicenter randomized control trial which JD Ricard is working on the use of nasal high flow in patients with acute hypercapnic respiratory failure. Thaïs Walter declares she has no competing interests.

Figures

Fig. 1
Fig. 1
Main benefits and complications associated with prone positioning extended beyond 24 h for intubated ARDS
See this image and copyright information in PMC

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