Acute Respiratory Distress Syndrome

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Abstract
We wonder why Ware and Matthay, in their review article on the acute respiratory distress syndrome (May 4 issue),1 neglect to discuss the role of prone positioning in the treatment of this disease. Prone positioning has been shown to improve the partial pressure of arterial oxygen in as many as 75 percent of patients with the acute respiratory distress syndrome and to permit a decrease in the required fraction of inspired oxygen and positive end-expiratory pressure.2,3 Prone positioning causes greater ventilation of dependent portions of the lung than supine positioning and may therefore be considered a lung-recruitment strategy.4 A number of randomized, controlled trials are being conducted to determine whether prone positioning changes the survival of patients with the acute respiratory distress syndrome.