Effect Of Prone Position in Acute Respiratory Distress Syndrome Patient: A Narrative Review
DOI:
https://doi.org/10.69980/ajpr.v28i4.408Keywords:
ARDS, COVID-19, PaO2, FiO2 RatioAbstract
INTRODUCTION: Acute Respiratory Distress Syndrome (ARDS) is a severe condition characterized by hypoxemia and lung inflammation, leading to high morbidity and mortality. Prone positioning has emerged as a promising intervention to improve oxygenation and outcomes in ARDS patients. This review synthesizes findings from 40 experimental studies, including randomized controlled trials, cohort studies, and observational studies, to evaluate the impact of prone positioning on oxygenation, mortality, and ventilation-related complications.
METHODS: A systematic literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on studies from France, Italy, Spain, USA, Canada, and India. The inclusion criteria consisted of experimental studies that assessed the impact of prone positioning on oxygenation (PaO₂/FiO₂ ratio), mortality, and adverse events in ARDS patients. Studies involving both mechanically ventilated and awake prone positioning in non-intubated patients were considered.
RESULTS: Prone positioning significantly improves oxygenation in ARDS patients, with studies showing a notable increase in the PaO₂/FiO₂ ratio, especially when maintained for 12–16 hours per day. It has been associated with a reduction in 28-day and 90-day mortality rates, particularly in severe ARDS cases. Evidence supports its role in reducing the need for intubation in non-intubated ARDS patients, especially during COVID-19-related respiratory failure. Prone positioning also facilitates better lung recruitment and reduces ventilator-induced lung injury. However, potential complications such as pressure ulcers, airway obstruction, and hemodynamic instability have been reported. Despite these risks, prone positioning is considered a safe and effective intervention when applied under proper clinical supervision.
DISCUSSION & CONCLUSION: Prone positioning has proven to be a clinically effective strategy in ARDS management, particularly when applied early and for prolonged durations. Its success is contingent on patient selection, protocol adherence, and multidisciplinary team expertise. Indian studies further highlight its utility in resource-limited settings, particularly during the COVID-19 pandemic. Future research should focus on long-term patient outcomes, personalized prone positioning strategies, and identifying optimal ARDS subgroups for maximum benefit.
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