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PRONE POSITIONING AS A THERAPEUTIC INTERVENTION FOR PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME Jeanette Hyde
Despite many new therapies to improve the survival of patients with acute respiratory distress syndrome (ARDS), mortality rates remain at approximately fifty percent. Prone positioning is one of the practices that have been employed in the management of ARDS. Objective: To review the available literature pertaining to the effects of prone positioning as a therapeutic intervention for ARDS patients. Methods: A computer search of Medline (1966-1999) and CINAHL (1982-1999) was performed using the key words prone positioning, ARDS, oxygenation, and outcome. Additional references were obtained from the articles produced by the computer search. The search yielded 35 articles. Relevant articles must have included patients meeting the clinical definition of ARDS, and reported on prone positioning as an intervention, either alone or in combination with other therapies. Five of the articles were not used because they did not report on subjects meeting the clinical definition of ARDS. Results: Of the 30 relevant articles, 12 were review articles on ARDS, 3 explained the mechanisms by which prone positioning works, 10 reported the physiological effects of prone positioning alone, and 5 reported on prone positioning in combination with other therapies (3 with nitric oxide, 1 with nitric oxide and almitrine bismesylate, and 1 with low-volume pressure-limited ventilation). Both alone and in combination with other therapies, prone positioning resulted in improvements in arterial oxygenation. Conclusions: The results of this review indicate that prone positioning should be an integral part of the management of ARDS patients. Further longitudinal studies need to be performed to provide conclusive evidence of the effects of prone positioning on the mortality rate of ARDS patients. Clinical Relevance: As therapeutic positioning is primarily the responsibility of the physical therapist, it is crucial to know the potential adverse effects and benefits of prone positioning.