Use of the prone position in the management of acute respiratory distress syndrome

Intensive Crit Care Nurs. 1999 Aug;15(4):192-203. doi: 10.1016/s0964-3397(99)80070-6.


The positioning of patients is usually within the domain of nursing practice, whether this is to achieve increased comfort or as a therapeutic intervention to avoid the occurrence of pressure sores. The use of the prone position to improve oxygenation, in the acute respiratory distress syndrome, has become increasingly popular in intensive care over the past decade (Thomas 1997). A systematic review was, therefore, undertaken to ascertain if the prone position did, in fact, improve oxygenation, leading to decreased mortality, or if the effects were merely transitory. Review findings indicate that use of the prone position does improve oxygenation, as measured by PaO2/FiO2 indices, and appears to reduce mortality. However, caution should be taken in applying these results to practice. First, the studies available for review demonstrated various methodological flaws. It is also apparent that untoward incidences associated with the prone position have yet to be investigated systematically.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Bias
  • Blood Gas Analysis
  • Critical Care / methods*
  • Evidence-Based Medicine
  • Humans
  • Oxygen / blood
  • Prone Position*
  • Research Design / standards
  • Respiratory Distress Syndrome / metabolism
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / nursing*
  • Respiratory Distress Syndrome / prevention & control*
  • Survival Analysis
  • Treatment Outcome


  • Oxygen