[ Critical Care CHEST Reviews ]

Prone Positioning for Acute Hypoxemic

Respiratory Failure and ARDS
A Review
Garrett L. Rampon, MD; Steven Q. Simpson, MD; and Ritwick Agrawal, MD

Prone positioning is an immediately accessible, readily implementable intervention that was

proposed initially as a method for improvement in gas exchange > 50 years ago. Initially
implemented clinically as an empiric therapy for refractory hypoxemia, multiple clinical trials
were performed on the use of prone positioning in various respiratory conditions, cumulating in
the landmark Proning Severe ARDS Patients trial, which demonstrated mortality benefit in
patients with severe ARDS. After this trial and the corresponding meta-analysis, expert
consensus and societal guidelines recommended the use of prone positioning for the man-
agement of severe ARDS. The ongoing COVID-19 pandemic has brought prone positioning to
the forefront of medicine, including widespread implementation of prone positioning in awake,
spontaneously breathing, nonintubated patients with acute hypoxemic respiratory failure.
Multiple clinical trials now have been performed to investigate the safety and effectiveness of
prone positioning in these patients and have enhanced our understanding of the effects of the
prone position in respiratory failure. In this review, we discuss the physiologic features, clinical
outcome data, practical considerations, and lingering questions of prone positioning.
CHEST 2023; 163(2):332-340

KEY WORDS: ARDS; COVID-19; hypoxemia; prone position

Before 2019, approximately 10% of all
admissions to ICUs fulfilled criteria for
ARDS,1 a condition associated with high
rates of morbidity, mortality, and treatment
cost.1-3 Pillars of supportive care for patients
with ARDS include low tidal volume
mechanical ventilation and implementation
of prone positioning, the act of turning a
patient on their chest and abdomen.
Historically, use of the prone position has
been limited to severe forms of diseases that
have progressed to ARDS. Since 2019, the
incidence of ARDS has skyrocketed, largely
in part because of the COVID-19 pandemic,
which has resulted in > 400,000,000 cases of
COVID-19 worldwide.4 Clinical findings
include high rates of acute hypoxemic
respiratory failure and progression to
ARDS,5-8 straining health-care systems and
providers globally. Very early in the
pandemic, physicians adapted treatment
strategies aimed at maximizing gas exchange
and adopted widespread use of the prone
position in patients with ARDS, as well as in
patients with impaired gas exchange who are
not mechanically ventilated, despite a

ABBREVIATIONS: APP = awake prone positioning; RR = relative risk
AFFILIATIONS: From the Division of Pulmonary, Critical Care, and
Sleep Medicine (G. L. R. and S. Q. S.), University of Kansas Medical
Center, Kansas City, KS, the Pulmonary Critical Care and Sleep
Medicine Section (R. A.), Medical Care Line, Michael E. DeBakey
Veteran Affairs Medical Center, and the Pulmonary Critical Care and
Sleep Medicine Section (R. A.), Department of Medicine, Baylor Col-
lege of Medicine, Houston, TX.
CORRESPONDENCE TO: Steven Q. Simpson, MD; email: ssimpson3@
kumc.edu
Copyright Ó 2022 Published by Elsevier Inc under license from the
American College of Chest Physicians.
DOI: https://doi.org/10.1016/j.chest.2022.09.020

332 CHEST Reviews [ 163#2 CHEST FEBRUARY 2023 ]

paucity of evidence that prone positioning is effective in
these conditions. In this review, we discuss the
physiologic rationale for prone positioning and its use in
intubated patients and nonintubated patients with acute
hypoxemic respiratory failure, the clinical outcome data
for the landmark trials of prone position in ARDS, the
results of recent clinical trials of prone positioning in
patients who are not intubated, practical considerations
for implementing prone positioning, lingering questions,
and future directions of study.
Physiologic Features
Human lungs play a critical role in cellular respiration
by efficiently transferring atmospheric oxygen to
human circulation. Nature seems to favor the prone
position for lungs, because most mammals, such as
dogs, cats, horses, and nonhuman primates, live
primarily in this position. The evolutionary upright
position exposes the human respiratory system to
different and complex physical and physiologic
interactions. These include the impact of gravitational
forces, the interaction of surrounding structures such
as the heart and diaphragm, body weight and habitus,
and pathophysiologic changes in the lungs,
vasculature, and pleura.9,10 The following
pathophysiologic changes explain positional
differences.
Ventilation
Changes in transpulmonary pressure during the
ventilatory cycle contribute to alveolar distension and
pulmonary ventilation. Transpulmonary pressure is
calculated as the difference between airway pressure
and pleural pressure. In the supine position, the
hydrostatic pressure generated by the weight of the
lungs, heart, and abdominal pressure leads to a more
negative pleural pressure ventrally (anteriorly in
humans).11 Consequently, while humans lie supine,
the alveoli are more distended anteriorly, in
comparison with the alveoli in the dorsal (posteriorly
in humans) half of the lungs, which are less distended.
These lesser-distended respiratory units may progress
to overt atelectasis when a patient remains in a
prolonged supine posture.12-16
When a supine patient changes to the prone position,
gravity and compression of surrounding structures
redistribute various dynamic pressures in the respiratory
system, as demonstrated in Figure 1. The posterior
pleural pressure becomes more negative compared with
anterior pleural pressure. The heart displaces toward the
sternum, and the surrounding diaphragm shifts
caudally. CT scans allow for specific quantification of the
ratio between gas and tissue in the volume between the
sternum and the vertebrae, enabling comparison

Figure 1 – Diagram showing the effect of the prone position on ventilation and perfusion. The lungs contain more alveolar units in the dorsal regions
than in the ventral regions. Thus, the effects of gravimetric compression disproportionally affect more alveoli in the dorsal region than in the ventral
region. When the patient assumes a prone position, the dorsal segments are more expanded, and therefore are able to participate more effectively in gas
exchange. A similar, although less pronounced, effect also occurs on perfusion.

chestjournal.org 333
 7 Shifting to the prone posture adds a few advantages.
6 The reversal of gravitational forces, shifting
Gas/Tissue Ratio
5
4 _
3 12-16,20,21
2 functional lung MRI showed that the V/
1 approaches 1 to 1.6 (anterior to posterior) in the
0 prone position, which is the most desirable. In
0 20 40 60 80 100
Sternum % distance Vertebra
Normal Supine Normal Prone
ARDS Supine ARDS Prone
Figure 2 – Graph showing the effect of the prone position on the gas to
tissue ratio (which may be thought of as a volume of the pulmonary
unit) as a function of the distance between the sternum and the verte-
brae. As shown, in the supine position, the gas to tissue ratio sharply
decreases from the sternum to the vertebrae, suggesting that both in
healthy people and in patients with ARDS, the distending force is about
three times higher closer to the sternum than to the vertebrae. In the
prone position, the gas to tissue ratio is far more homogeneous, indi-
cating a more even distribution of forces throughout the lung paren-
chyma. (Reprinted with permission from Guerin et al.18)
between supine and prone positions, demonstrated in
Figure 2.17 The prone position ultimately leads to a more
homogeneous distribution of ventilation by inflation of
underinflated or collapsed posterior airways and
reduction in anterior alveolar hyperinflation.12-16
Although improved positional ventilation homogeneity
is crucial in capturing atmospheric or supplemental
oxygen, its positive impact on oxygenation can be
achieved only if an equivalent matching of pulmonary
perfusion exists. Ideally, the adequately ventilated alveoli
should have matching, adequate blood flow, thus using
their full potential to transfer the oxygen to the
_ Q_ ratio is 1, implying that all of
circulation. The ideal V/
the ventilated oxygen is exposed to perfusing vessels.
Any disparities of ventilation and perfusion lead to a
mismatch of ventilation and perfusion, ranging in a
continuum from dead space to shunt and resulting in
_ Q_ values either higher or lower than 1, respectively.19
V/
Perfusion
In the supine position, gravitational forces lead to higher
perfusion in the posterior alveoli. As noted earlier, these
posterior alveoli are poorly ventilated and often are
collapsed. Thus, posterior alveoli that are the recipients
of the highest perfusion are relatively poorly ventilated.
However, the better-ventilated anterior alveoli receive
relatively lower perfusion. These factors lead to a greater
degree of V/ _ mismatch in a supine patient, leading to
_ Q
poor oxygenation.
334 CHEST Reviews
surrounding structures such as the heart and
diaphragm, ultimately leads to more homogeneous
_ Q
lung perfusion. Prone positioning improves the V/
ratio. A recent study using high-resolution
_ ratio
_ Q
_ Q_ ratio ranges from 1.6 to 3
contrast, the supine V/
from posterior to anterior regions.12
Numerous physiologic studies of ventilation and
perfusion have been performed since the 1960s using a
variety of methods, including radiospirometry, single-
photon emission CT scan imaging, PET scan imaging,
and MRI.22 Although some studies demonstrated no
changes in positional shifts in ventilation and perfusion,
most studies, including more recent ones that used
higher-resolution functional MRI, suggested
improvement in the V/ _ gradient while patients were in
_ Q
12
the prone position.
Under normal healthy circumstances, differences in
body position have little impact on overall
oxygenation because of robust compensatory
mechanisms such as high reserves for ventilation and
perfusion. However, positional changes can impact a
diseased and compromised respiratory system
substantially. Prone positioning may lead to better
oxygenation in one group of patients, whereas others
may not realize differences, because numerous
complex factors must interact to improve oxygenation.
These factors include degree and location of
pathophysiologic processes, such as atelectasis,
consolidation, pulmonary interstitial involvement, local
and regional differences in perfusion, the impact of
hypoxemic vasoconstriction, cardiac output, and
anemia. Additionally, specific interventions can
supplement the impact of prone positioning: addition
of positive end-expiratory pressure by mechanical
ventilation or high-flow nasal cannula, reducing
patient-ventilator dyssynchrony by sedation and
neuromuscular blocking agents, and using medications
that help to improve pulmonary vascular bed flow and
cardiac output.23–26
Clinical Outcomes
ARDS
The prone position has been well studied for the
treatment of moderate to severe ARDS. The first major
[ 163#2 CHEST FEBRUARY 2023 ]
trial, performed by Gattinoni et al24 and published in

Guerin et al32 (2013)

0.48 (P < .001)

2001, did not demonstrate significant improvement in

PaO2 to FIO2 <

150 mm Hg
mortality or ventilator-free days. However, as

466

6.1

7.4
17
4
understanding of the care for patients with ARDS has
improved, several limitations to this trial became
apparent, including the lack of lung-protective
ventilation strategy (average tidal volume (Vt)

0.97 (P ¼ .72)
Taccone23 (2009)

PaO2 to FIO2 <

delivered, 10.3 mL/kg) and limited time in the prone

200 mm Hg
position (average, 7 h/d). Study design evolved over

11.5
344

8.0
18
8
time, and multiple studies were performed with major
changes, including the implementation of lung-
protective ventilation, increased duration of time in the
prone position, increased statistical power, and

0.724 (P ¼ .360)
Fernandez et al31

PaO2 to FIO2 <

Not reported
200 mm Hg
initiation of the prone position earlier after onset of

7.1-9.2
(2008)

10.5
ARDS.23,27–31 Table 1 represents a summary of major

42

18
trials of prone positioning in patients with severe and
moderate to severe ARDS.
The Proning Severe ARDS Patients (PROSEVA) trial,

0.786 (P ¼ .18)
PaO2 to FIO2 <
Mancebo et al29
published in 2013, is the landmark trial that

200 mm Hg
(2006)
demonstrated a mortality benefit to the prone position

142

8.5

8.3
17
10
for patients with severe ARDS (mortality, 16% vs 32.8%;
P < .001) and a reduction in ventilator-free days. Several
possible explanations exist for why PROSEVA
demonstrated a mortality benefit when the other studies
Voggenreiter et al28

0.34 (P ¼ .282)
PaO2 to FIO2 <
300 mm Hg
did not. PROSEVA used the lowest tidal volumes of any
(2005)

6-8a
study at 6 mL/kg of ideal body weight. Additionally, it
40

11
7

0
was the largest study with the highest power and the
lowest rate of crossover from supine to prone position.

Per report of study design, “Tidal volumes were kept between 6 and 8 mL/kg body weight.”
In a meta-analysis on the effect of prone position for 1.02 (P ¼ .77)
PaO2 to FIO2 <
] Summary of Major Trials of Prone Positioning in ARDS

300 mm Hg
Guerin et al25

the treatment of ARDS, the mortality benefit was

(2004)

21.4
7.9b
802

observed in a subgroup analysis of prone position

9
4

performed for > 12 h/d, compared with < 12

h/d (risk ratio [RR], 0.74; 95% CI, 0.56-0.99; P ¼
Tidal volume given in milliliters per kilogram of measured body weight.
.05) and in patients with moderate to severe ARDS
compared with those with mild ARDS (RR, 0.74;
1.05 (P ¼ .65)
PaO2 to FIO2 <
Gattinoni et al24

300 mm Hg

95% CI, 0.56-0.99; P ¼ .05).33 A separate meta-

(2001)

10.3
304

7.9
10
7

analysis found a decrease in mortality in trials that

used low (< 8 mL/kg) tidal volume compared with
high (> 8 mL/kg) tidal volume (RR, 0.66; 95% CI,
0.50-0.86; P ¼ .002).34
Tidal volume delivered, mg/kg

With this evidence, the American Thoracic Society/

Average No. of days prone

Crossover from supine to

Relative risk of mortality
Average time prone, h/d

European Society of Intensive Care Medicine/Society of

(ideal body weight)

Critical Care Medicine clinical practice guidelines

strongly recommended prone positioning for > 12
(prone/control)
Inclusion criteria
No. of patients

h/d for patients with severe ARDS.35 Similarly, the

prone, %

French Society of Intensive Care Medicine for ARDS

management strongly recommended use of the prone
Variable
TABLE 1

position for patients with ARDS with PaO2 to FIO2 ratio

of < 150 mm Hg.36
b
a

chestjournal.org 335
Awake Prone Positioning
Interest in the prone position in awake, spontaneously
breathing, nonintubated patients—commonly referred
to as awake prone positioning (APP)—grew in response
to the COVID-19 pandemic. In the face of an increasing
need for therapies to reduce the need for advanced
respiratory care, clinicians adopted widespread use of
APP in nonintubated patients with ARDS, patients with
severe COVID-19, and patients with mild COVID-19,37
a practice supported by societal and National Institutes
of Health guidelines.38,39
The role of APP since has been investigated in
randomized controlled clinical trials in patients
requiring high-flow nasal cannula, noninvasive
positive pressure ventilation, or both,40–42 as well as
in patients with minimal or no supplemental oxygen
requirement,43–46 and data are summarized in Table 2.
The largest of these studies, by Ehrmann et al,40
was a prospective collaborative meta-trial of six
randomized controlled trials of 1,121 patients with
acute hypoxemic respiratory failure requiring a high-
flow nasal cannula. The a priori defined composite
end point was treatment failure requiring intubation
or death. APP was superior to supine positioning
(40% vs 46%; RR, 0.86; 95% CI, 0.75-0.98). The
superiority of APP in this patient population was
driven by lower intubation rate, because no specific
mortality benefit was demonstrated.
Results from other large randomized controlled trials
have demonstrated conflicting findings. Alhazzani et al42
included 400 patients requiring at least 40% oxygen via
either traditional nasal canula, high-flow nasal canula, or
noninvasive positive pressure ventilation to undergo
APP or supine positioning and found an absolute
decrease in the primary outcome of rate of intubation
(34.1% vs 40.5%); however, these results were not
statistically significant. Subgroup analysis suggests a
statistically significant reduction in rates of intubation in
patients requiring high-flow nasal canula; however, these
findings also showed high false-discovery rates, which
may limit interpretation. This study was limited by
adjustments in study sample size and imprecise effect
size. Rampon et al44 included 293 patients receiving < 6
L/min of supplemental oxygen to receive electronic
recommendations to undergo APP or usual care and
found no difference in rates of worsening oxygenation or
ICU transfer. This study was limited by low rates of
protocol adherence. Qian et al45 performed a
nonrandomized controlled trial of 501 patients assigned
to receive APP or usual care and found no difference in
336 CHEST Reviews
World Health Organization ordinal outcomes scale by
days 14 or 28.
In a meta-analysis of 11 randomized controlled trials
and 19 nonrandomized controlled trials of APP totaling
2,669 patients,48 APP significantly reduced the
intubation rate (RR, 0.85; 95% CI, 0.74-0.98), a finding
driven primarily by patients requiring high-flow nasal
cannula and noninvasive positive pressure ventilation.
No criteria for intubation were predefined, and
indications for intubation differed from institution to
institution as the pandemic and understanding of viral
transmission evolved. The duration of APP procedures
among these studies varied widely, ranging from 1 to 16
h, with many of them targeting as long as the patient
comfortably tolerated the prone position. Reported
duration of time spent in the prone position varied from
study to study and frequently was estimated
unsystematically and with unknown accuracy. None of
the trials that enrolled patients with a standard nasal
cannula demonstrated a significant difference in
intubation rate between APP and supine groups. One
trial demonstrated increasing odds of higher oxygen
support needed in patients undergoing APP.45 It is
unclear if this lack of response in milder disease is the
result of a lack of physiologic effect, inability for patients
to remain prone routinely for longer durations, or a
combination of the two.
Practical Considerations
Despite consensus recommendations and societal
guideline recommendations,35,36 prone positioning
historically has been underused. A 2016 prospective
observational study (Large Observational Study to
Understand the Global Impact of Severe Acute
Respiratory Failure) of 3,022 patients with ARDS found
that only 16.3% of patients with severe ARDS were
treated with prone positioning.1 This may be because of
underrecognition of indications and contraindications
for prone positioning, perceived logistical challenges of
prone positioning, or concerns of complications of
prone positioning.
The authors routinely use and recommend a trial of
prone positioning for all patients with ARDS because of
demonstrated mortality benefit in moderate to severe
ARDS. We additionally recommend consideration of
awake prone positioning for patients with acute
hypoxemic respiratory failure from a suspected
inflammatory process (eg, COVID-19 or influenza
pneumonia) requiring a high-flow nasal cannula or
[ 163#2 CHEST FEBRUARY 2023 ]
 TABLE 2 ] Summary of Major Trials of APP in Respiratory Failure
chestjournal.org

Jayakumar et al43 Alhazzani et al42

Variable Ehrmann et al40 (2021) (2021) Rosen47 (2021) Qian et al45 (2022) Fralick et al46 (2022) Rampon et al44 (2022) (2022)
No. of patients 1,121 60 75 501 248 293 400
Enrollment ICU, intermediate ICU ICU, general ICU, intermediate General ward General ward ICU,
location care, general ward ward care, general ward monitored
acute care
unit
Average time 5.0 Averages not 3.4 (usual 4.2 0.0 (usual care), Averages not 5.0
prone, h/d reporteda care), 9.0 2.5 (APP) reportedb
(APP)
Baseline PaO2 117.3 (usual care) 185 (usual care) 115.5 Unavailable 293c 396 134c
to FIO2 ratio 119.3 (APP) 201 (APP)
Primary Treatment failure, Protocol Intubation Highest level of Composite of Composite of Endotracheal
outcome defined as adherence within 30 d oxygen support on respiratory respiratory intubation
intubation or death day 5 deterioration, deterioration and within 30 d
mechanical transfer to an ICU
ventilation, and
death
Key secondary Intubation, mortality, Escalation of Mortality, Daily oxygen support Respiratory Time spent in prone Mortality at
outcomes use of NIV, length of respiratory clinical device and deterioration, position, 60 d,
hospital stay, others support, ICU improvement maximum FIO2 mechanical subjective ventilator-
mortality, length at 7 and 30 d, ventilation, dyspnea, free days,
of ICU stay ventilator- death, time in mortality, ICU-free
free days, prone position, hospital length of days,
length of ICU improved stay, hospital-
stay oxygenation development of free days
ARDS
Results Treatment failure 43% of patients No difference in No difference in rates No difference in No difference in No difference
occurred in 223 were able to rates of of intubation or primary or primary or in primary
patients (40%) in prone > 6 h/d; primary or mortality secondary secondary or
prone group and no difference in secondary outcomes; low outcomes; low secondary
257 patients (46%) secondary outcomes rates of self- rates of self- outcomes
in usual care group outcomes prone positioning prone positioning
(P ¼ .02) between groups

APP ¼ awake prone positioning; NIV ¼ noninvasive ventilation.

a
No. of hours spent in the prone position: > 6 h, 13 (43%); 4-5 h, 5 (17%); 1-4 h, 4 (13%); < 1 h, 2 (7%); 0 h, 2 (7%).
b
Seventy-one percent of patients in the prone position group reported prone positioning at least once, and 35.7% reported prone positioning for $ 6 h at least once. In the usual care arm, 59.4% reported prone
positioning at least once, and 13% reported prone positioning for > 6 h.
c
PaO2 to FIO2 ratio.
337
noninvasive positive pressure ventilation because of
evidence suggesting lower rates of mechanical
ventilation when APP is implemented. Awake prone
positioning in patients with milder hypoxemic
respiratory failure may be considered despite lack of
benefit observed in clinical studies, because the available
data suggest that patients who do tolerate longer
proning sessions of $ 6 to 8 h may benefit from prone
positioning.49,50
The only absolute contraindication to prone positioning
is an unstable spinal fracture. Relative contraindications
include recent sternotomy, large ventral surface area
burns, unstable pelvic or long bone fractures, elevated
intracranial pressure, and massive hemoptysis.
Pregnancy should not be considered a contraindication
because prone positioning has been performed safely
during pregnancy51–53 and is recommended, along with
pictorial how-to guides, by the American College of
Obstetrics and Gynecology for refractory hypoxemia
associated with COVID-19.54 Evidence of increased
work of breathing, respiratory distress, or CO2 retention
may be considered relative contraindications to APP,
and studies of APP generally have avoided including
patients with such findings.
Complications resulting from prone positioning are rare.
In the PROSEVA study, no statistical differences were
found in nonscheduled extubation, hemoptysis,
mainstem bronchus intubation, or cardiac arrest
between groups.32 Meta-analysis of eight randomized
controlled trials detected that patients with ARDS who
underwent prone positioning showed had higher rates of
endotracheal tube obstruction (RR, 1.76; 95% CI, 1.24-
2.50) and pressure sores (RR, 1.22; 95% CI, 1.06-1.41).33
APP also is safe, with studies demonstrating no
increased risks of complications55 or slightly increased
rates of skin breakdown, line dislodgement, back pain,
or generalized discomfort.42,44,48
Lingering Questions and Future Directions
The pathophysiologic features of early lung injury and
the progression to ARDS remain incompletely
understood. Animal models suggest that early prone
positioning may help to minimize the progression of
lung injury56,57; however, this remains a clinical area of
uncertainty. Further work with emerging imaging
technology, including electrical impedance
tomography,58 CT scan quantification of regional
ventilation metrics,59 and hyperpolarized lung MRI22
may help clinicians to understand better the physiologic
338 CHEST Reviews
features of prone positioning and the optimize clinical
use of the technique.
Several clinical questions remain regarding the optimal
timing and implementation of prone positioning in
ARDS. The optimal duration of prone positioning
sessions is not determined definitively, with
recommendations ranging from $ 12 to $ 16 h/d or
more. It also remains unclear when to discontinue
episodes of prone positioning. In PROSEVA, prone
positioning was stopped when the PaO2 to FIO2 ratio
remained > 150 mm Hg 4 h after transition to supine
positioning, with positive end-expiratory pressure of
< 10 cm H2O and FIO2 of < 0.6, but it is unclear if
continuing proning sessions beyond this point could
provide additional benefit. Further, these criteria would
not apply to patients whose hypoxemia is less severe,
that is, with PaO2 to FIO2 ratio of > 150 mm Hg at the
onset of prone positioning. At a minimum, we
recommend continuing until a clear improvement in gas
exchange, with diminishing oxygen requirements, and
overall improvement in clinical course occur.
Uncertainties remain regarding the optimal patient
population, the timing, and the duration of APP.
Trials40,42 and metanalysis48 suggest that APP is
beneficial for patients requiring high-flow nasal cannula;
however, these studies have not been designed
specifically for or powered to determine the optimal
patient population. Clinical trials of APP have used
different durations, often based on patient tolerability,
leaving the therapeutic duration unknown. Finally, data
on the effectiveness of APP currently are limited to
patients with COVID-19. Studies of APP should be
performed in other causes of acute hypoxemic
respiratory failure to confirm clinical benefit across
different disease states.
Conclusions
The use of the prone position has numerous physiologic
benefits in patients with acute hypoxemic respiratory
failure and ARDS. Although historically implemented as
rescue therapy for refractory hypoxemia, prone
positioning became the standard of care for ARDS after
mortality benefit identified in randomized controlled
trials in this patient population. Throughout the
COVID-19 pandemic, prone positioning has been
implemented widely and studied in patients with acute
hypoxemic respiratory failure without ARDS, including
nonintubated patients, with some studies demonstrating
meaningful clinical benefit including reduced rates of
[ 163#2 CHEST FEBRUARY 2023 ]
mechanical ventilation. Clinicians managing patients
with hypoxemic respiratory failure should have a firm
understanding of the physiologic features and clinical
benefits of prone positioning and be ready to implement
it in acute hypoxemic respiratory failure and ARDS.
Financial/Nonfinancial Disclosures
None declared.
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