Prone Positioning

Prone positioning is more than a manoeuvre that raises the oxygen saturation. In severe acute respiratory distress syndrome (ARDS), turning the patient onto the abdomen changes the relationship between the heavy, injured lungs, the chest wall, the heart, and pulmonary blood flow. The result is usually more even ventilation, better matching of ventilation to perfusion, and less regional ventilator stress. The benefit depends on patient selection and dose. For an adult receiving invasive mechanical ventilation with severe ARDS, proning is a prolonged, protocolized treatment delivered alongside lung-protective ventilation—not a one-time rescue response to an isolated low SpO₂. A patient may look better after the turn without having completed the treatment that reduces mortality. This is a high-risk procedure. The airway, vascular access, drains, eyes, skin, limbs, nutrition, and hemodynamics must be managed as one system by a coordinated team. Awake proning has a separate role in selected, cooperative, spontaneously breathing adults, particularly in COVID-19-related hypoxemic respiratory failure. It is not an alternative to intubation when respiratory effort or mental status is deteriorating. Pediatric ARDS should not be managed by transferring...