What is the role of prone positioning in ventilated patients with COVID-19 ARDS?

Early prone positioning is generally recommended in these patients. If tolerated, this is also a good strategy for awake patients with non-invasive ventilation.

Prone positioning theoretically makes ventilation more homogeneous by decreasing ventral alveolar distention and dorsal alveolar collapse . This may reduce the difference between the dorsal and ventral transpulmonary pressures, in addition to reducing lung compression and improving perfusion.

Prone ventilation for more than 12 hours in patients with moderate to severe ARDS reduces mortality, but may increase the risk of pressure sores and endotracheal tube obstruction. Healthcare workers proning patients with COVID-19 should be trained in the proper technique for proning and take infection control precautions in the event of accidental endotracheal tube disconnection from the ventilator.