To prone or not to prone ARDS patients on ECMO
by Oriol Roca, Andrés Pacheco and Marina García-de-Acilu
Critical Care volume 25,
Article number: 315 (2021) Published: 31
August 2021
The prone position is recommended as a supportive therapy in
patients with moderate- to-severe acute respiratory distress syndrome (ARDS).
It is usually associated with improved oxygenation and pulmonary mechanics as
the result of a more homogeneous distribution of mechanical forces and better
ventilation/perfusion (V/Q) matching. These effects lead to a lower risk of
aggravating preexisting lung injury and, ultimately, a decrease in mortality.
Despite widespread use of the prone position in patients with ARDS, even in
awake non-intubated spontaneously breathing patients, its use dramatically
decreases once the patient has been placed on extracorporeal membrane
oxygenation (ECMO). In this chapter, we discuss the available evidence
regarding use of the prone position in ARDS patients treated with ECMO.
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