Should Early Prone Positioning Be a Standard of Care in ARDS With Refractory Hypoxemia?

• Published in: Respiratory care Vol. 61; no. 6; pp. 818 - 829
• Main Authors: Marini, John J, Josephs, Sean A, Mechlin, Maggie, Hurford, William E
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01.06.2016
• Subjects: Acute respiratory distress syndrome; Care and treatment; Health aspects; Humans; Hypoxia; Hypoxia - complications; Hypoxia - therapy; Prone Position; Respiration, Artificial - methods; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Standard of Care; United Kingdom; respiratory failure; refractory hypoxemia; prone position; mechanical ventilation; ARDS; secretion clearance
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.04562

For the past 4 decades, the prone position has been employed as an occasional rescue option for patients with severe hypoxemia unresponsive to conventional measures applied in the supine orientation. Proning offers a high likelihood of significantly improved arterial oxygenation to well selected patients, but until the results of a convincing randomized trial were published, its potential to reduce mortality risk remained in serious doubt. Proning does not benefit patients of all disease severities and stages but may be life-saving for others. Because it requires advanced nursing skills and escalation of monitoring surveillance to deploy safely, its place as an early stage standard of care depends on the definition of that label.