Prone the lung and keep it prone!

Prone positioning (PP) has been used for a long time as a rescue therapy for severe hypoxemia in patients with ARDS because of its effectiveness in improving oxygenation and in reducing mortality in those with a more compromised Pao2 to Fio2 ratio (ie, < 150 mm Hg).1 Nevertheless, despite that the clinical indication for PP is to improve gas exchange, its benefits on mortality may be related to its veiled effects on stress and strain distribution, lung concentration of proinflammatory cytokines,2,3 and aeration and ventilation distribution throughout the lung.4,5 To sum up, its potential effects reduce the risk of ventilator-induced lung injury.