What now for prone positioning?

Prone positioning improves oxygenation by optimizing lung recruitment and ventilation-perfusion matching. Beyond its value in improving gas exchange, prone positioning helps protect against VILI by distributing stress and strain more homogeneously through the lung parenchyma. These beneficial effects appear to confer a survival advantage in patients with severe forms of ARDS, where the preconditions for prone positioning to work are fully expressed. Its long term use is not indicated for mild/moderate ARDS, with PaO2/FiO2 greater than150 mmHg as it may expose the patient to unnecessary risk of complications in absence of proven benefits. Prone positioning does not require special equipment but should be performed only by specifically trained personnel and undertaken with great care to minimize the risk of any potential life-threatening complications.