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Prone positioning in the ICU 

Prone positioning in the ICU
Prone positioning in the ICU

Paolo Taccone

and Davide Chiumello

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date: 23 February 2020

Prone positioning (also known as ‘proning’, ‘prone manoeuvre’ or ‘prone ventilation’) refers to mechanical ventilation with patients positioned in prone position in contrast of standard supine (flat or semi-recumbent) position. The use of the prone positioning was proposed over 30 years ago as a means to improve arterial oxygenation in patients with acute respiratory distress syndrome (ARDS). Since then, extensive physiological research has been conducted to explore the possible mechanisms underlying the observed improvement in gas exchange, which involve changes in the distribution of both ventilation and pulmonary blood flow. Furthermore, it has been shown that, independently of gas exchange, prone positioning may reduce the harm of mechanical ventilation, which is known to adversely impact patient survival. In this chapter we will summarize the physiological effect of prone positioning, as well as the clinical evidences supporting its use to reduce mortality in patients with ARDS.

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