Review Article - International Journal of Respiratory Medicine (2021) Volume 6, Issue 1

Prone ventilation - It’s a challenge

Prone Position ventilation (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS/ALI because of its effectiveness at improving gas exchange. Meta-analyses have suggested better survival in patients with an arterial oxygen tension (PaO₂)/inspiratory oxygen fraction (FIO₂) ratio, 100 mmHg. A recent randomized controlled PROSEVA study trial was performed in ARDS patients in 2013 after a stabilization period of 12-24 h and severity criteria (PaO₂/FIO₂-150 mmHg at a positive end-expiratory pressure >5 cm H₂O). This randomized control study showed a significant reduction in mortality in prone group 32.8% versus in supine group 16% (P-0.001). The main goal of this article are to discuss about prone position ventilation which improves oxygenation in patients with ALI/ARDS; the evidence of its use based on trial analysis; and the limitations of its use as well as the current place of prone positioning in the management of patients with ALI/ARDS. Since 2013 after PROSEVA study trial proning has become more common in our ICUs. Although best clinical judgment to follow the PROSEVA trial’s protocol as a guideline are used and remains inconsistency in the timing and duration of proning in ARDS patients.

Author(s): Umesh Kumar Bylappa*, Khair Muhammad Burki, Ali Hiis Jillal, Roman Romulo S, Manrique JR, Albin Chacko

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