Faculty Opinions recommendation of Prone positioning in severe acute respiratory distress syndrome.

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Abstract
While it was realized in the 1970s that prone positioning improved oxygenation in acute respiratory distress syndrome (ARDS), numerous studies over ensuing decades demonstrated improvement in oxygenation but failed to show improved mortality from prone positioning. In this 2013 study, Guerin et al. examined prone positioning (at least 16 hours/day) vs. standard positioning in 466 severe ARDS subjects and found a striking 28d mortality benefit of prone positioning (32.8% supine vs. 16% prone), which persisted until day 90. Of note, there was no significant difference in complications between the prone and supine groups (with the exception of an increased rate of cardiac arrests in the supine group); however, the authors acknowledge that this study was carried out in centers with substantial experience and expertise in prone positioning. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Rebecca M. Baron and Bruce D. Levy.

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