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Prone Positioning: Early Intervention, Not Rescue
Clinical Scenario
A 72-year-old male on mechanical ventilation for ARDS day 5 has a plateau pressure of 32 cmH2O despite low tidal volumes. His P/F ratio is 120. The team is discussing further ventilator management str...
Teaching Pearl
For patients with moderate to severe ARDS (P/F ratio < 150 mmHg), early and prolonged prone positioning significantly reduces 28-day mortality. The PROSEVA trial demonstrated a mortality benefit when patients were proned for at least 16 hours daily. Remember: Prone early, prone long. A common pitfal...
Ref: NEJM 2013 — PROSEVA trial for prone positioning in ARDS
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Featured Content
Browse LibraryVentilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome (ARMA / ARDSNet)
Use 6 ml/kg predicted body weight tidal volumes in all patients with ARDS. This is the single most important intervention in ARDS management and is standard of care worldwide. Plateau pressure should be kept ≤30 cmH₂O.
Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA)
Prone positioning ≥16 hours/day should be used in all patients with severe ARDS (P/F <150) who are on lung-protective ventilation. This is a strong recommendation in current ATS/SCCM guidelines.
A Randomized Trial of Protocol-Based Care for Early Septic Shock (ProCESS)
Protocolized EGDT (with ScvO₂ monitoring, CVP targets, and blood transfusions) is not superior to usual care in septic shock. The key elements that matter are: early recognition, prompt antibiotics, and adequate resuscitation — not the specific protocol endpoints.