Face Down Positioning is Effective For Acute Respiratory Distress Syndrome

This article from the New England Journal of Medicine demonstrates that placing patients face-down while intubated for a condition known as acute respiratory distress syndrome (ARDS) significantly improves survival. Roughly 230 patients were divided into different treatment groups. In one group, the patients with acute respiratory distress syndrome were placed face-down while in the other group, patients were placed on their back. The unadjusted ninety-day mortality was 23.6% in the facedown/prone group versus 41% in the face up/supine group. 

This is a method of ventilation not customarily seen in the United States.  The online version of the New England Journal of Medicine contains a video which demonstrates the procedure for physicians and ICU nurses to learn if they wish to. Of note in the study is the center where this was conducted there was a 5 year experience with this unusual method of ventilatory support. Obviously if this method of ventilation is to be tried US there’ll be a learning curve for the treatment team.

Bottom-line: A respiratory syndrome commonly seen in critically ill patients known as ARDS was treated with a novel method of ventilation involving placing patients facedown for 12-16 hours a day resulted in a 42% difference in survival at 90 days. This is dramatic and warrants peer-review by physicians and ICU teams. If such a dramatic improvement can be demonstrated in the United States there can be a significant positive impact on patient survival for a condition associated with very high mortality.