Prone Positioning of Patients with Acute Respiratory Failure

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Abstract
Gattinoni et al. (Aug. 23 issue)1 reported that placing patients with acute respiratory failure in a prone position improved their oxygenation but not their survival. One reason why improved oxygenation did not translate into a reduction in mortality might be that the duration of pronation was too short — only seven hours per day on average — as pointed out by Slutsky in his editorial.2 In our nine-year experience with prone positioning of patients during ventilation, we have used a different protocol.3,4 We use the same indications and timing that Gattinoni et al. used, but we do not return our patients to the supine position before their gas-exchange deficit has resolved. Therefore, patients do not have decreased oxygenation while they are in the supine position. Adverse events related to the turning procedure are avoided. The nursing workload is decreased, enhancing adherence to the protocol.