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10.11.2020 | Review

Prone position in ARDS patients: why, when, how and for whom

verfasst von: Claude Guérin, Richard K. Albert, Jeremy Beitler, Luciano Gattinoni, Samir Jaber, John J. Marini, Laveena Munshi, Laurent Papazian, Antonio Pesenti, Antoine Vieillard-Baron, Jordi Mancebo

Erschienen in: Intensive Care Medicine | Ausgabe 12/2020

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Abstract

In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependent lung regions and less cyclical opening and closing in dependent lung regions. The only absolute contraindication for implementing prone position is an unstable spinal fracture. The maneuver to change from supine to prone and vice versa requires a skilled team of 4–5 caregivers. The most frequent adverse events are pressure sores and facial edema. Recently, the use of prone position has been extended to non-intubated spontaneously breathing patients affected with COVID-19 ARDS. The effects of this intervention on outcomes are still uncertain.

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Titel: Prone position in ARDS patients: why, when, how and for whom
verfasst von: Claude Guérin
Richard K. Albert
Jeremy Beitler
Luciano Gattinoni
Samir Jaber
John J. Marini
Laveena Munshi
Laurent Papazian
Antonio Pesenti
Antoine Vieillard-Baron
Jordi Mancebo
Publikationsdatum: 10.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06306-w

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