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Semin Respir Crit Care Med 2019; 40(01): 094-100
DOI: 10.1055/s-0039-1685180
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prone Positioning in Acute Respiratory Distress Syndrome

Luciano Gattinoni
1   Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
,
Mattia Busana
1   Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
,
Lorenzo Giosa
1   Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
,
Matteo Maria Macrì
1   Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
,
Michael Quintel
1   Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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Publikationsdatum:
06. Mai 2019 (online)

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Abstract

Prone positioning is nowadays considered as one of the most effective strategies for patients with severe acute respiratory distress syndrome (ARDS). The evolution of the pathophysiological understanding surrounding the prone position closely follows the history of ARDS. At the beginning, the focus of the prone position was the improvement in oxygenation attributed to a perfusion redistribution. However, the mechanisms behind the prone position are more complex. Indeed, the positive effects on oxygenation and CO2 clearance of the prone position are to be ascribed to a more homogeneous inflation–ventilation, to the lung/thoracic shape mismatch, and to the change of chest wall elastance. In the past 20 years, five major trials have tried, starting from different theories, hypotheses, and designs, to demonstrate the effectiveness of the prone position, which finally found its definitive place among the different ARDS supportive therapies.

Keywords

Acute Respiratory Distress Syndrome - ARDS - prone position - trial design - oxygenation - shape mismatch - chest wall elastance