Prone positioning in ARDS
In brief
Prone positioning consistently boosts oxygen levels in intubated and awake ARDS patients
Across five decades of research, placing ARDS patients prone improves oxygenation whether they are on a ventilator or breathing spontaneously, and early prone use is now a standard part of lung-protective ventilation for severe cases. The maneuver also lessens lung stress and may aid circulation, but its impact on mortality in non-COVID, non-intubated patients still needs confirmation.
- Journal
- Intensive care medicine (Q1)
- Published
- 20 July 2026
- Study design
- Narrative review / expert opinion
- Evidence level
- Level 1, High (CEBM 5)
- Authors
- Stephan Ehrmann, Jie Li, Ling Liu, Claude Guérin
- PMID
- 42474726
- DOI
- 10.1007/s00134-026-08543-x
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 21 July 2026): Prone positioning in ARDS review (clinical focus)
- Picked for Family Practice (paper of the day, 21 July 2026): Recent Family Practice research from a high-quartile journal.
Abstract
Over the past five decades, prone positioning has evolved from single case reports to an evidence-based intervention. Initially used as a rescue therapy, it is now recognized as an integral component of lung-protective mechanical ventilation strategies, applied early in intubated patients with acute respiratory distress syndrome (ARDS) with a PaO2/FIO2 ratio < 150 mmHg. The COVID-19 pandemic further expanded its use to non-intubated patients, the so-called awake prone position (APP), with promising results. APP requires confirmation in non-COVID patients and in a more routine ICU practice. Improved oxygenation is a consistent and well-recognized effect of prone positioning in both intubated and non-intubated patients with ARDS. Beyond its effects on gas exchange, prone positioning mitigates ventilator-induced lung injury by reducing lung stress and strain and may also confer favorable hemodynamic effects. This article reviews the physiologic rationale for prone positioning, evidence from randomized controlled trials, current guideline recommendations, practical aspects of implementation, and ongoing questions in both intubated and non-intubated patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.