Discussion Forum


JOURNAL CLUB - Prone position in mechanically ventilated patients

By: Marcelo Alcantara, Médico - 07/11/2022 21:20

In this series of review articles entitled LASTING LEGACY IN INTENSIVE CARE MEDICINE, we highlight this paper that addresses THE PRONE POSITION IN VENTILATED (INTUBATED) PATIENTS.

The best-known author is Dr. Claude Guérin, from Lyon, France, the first author of the 2013 PROSEVA study.

The single figure of the article is presented here and summarizes the authors' main points addressed in a very synthetic way.

Did you know that this position has been with us in treating ARDS for about 45 years!?

All the essential points for adopting this adjuvant treatment strategy for patients with moderate to severe ARDS are presented.

We highlight 5 points among several addressed in the text:

1- The prone position improves gas exchange, especially oxygenation.

2- Attenuates factors associated with the evolution of ventilator-induced lung injury, VILI.

3- Does not worsen hemodynamics (or cor pulmonale) of patients with ARDS

4- Must be applied after optimization of initial adjustments with protective MV

5- Requires teamwork with experience and training

Below is the link to the paper:

Papazian L, Munshi L, Guérin C. Prone position in mechanically ventilated patients. Intensive Care Med. 2022 Jun 2:1–4. doi: 10.1007/s00134-022-06731-z.

The references are handy. A didactic video published as a supplement to the PROSEVA study is cited. Click on the link below to watch it.

Digital Object Thumbnail Video Prone Positioning of Patients with the Acute Respiratory Distress Syndrome (ARDS) (05:11)

I believe we evolved in applying the prone position in moderate or severe ARDS, and I used it a lot in patients with severe COVID-19. 

What about you? Have you had a good personal experience with prone positioning? 

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