Q; Which of the following is the limitation factor in institution of prone positioning in ARDS?

A) Long list of contra-indications
B) patient already on ARDSnet protocol for low tidal volume
C) Patient still in early acute ARDS phase
D) No major trials or evidence based benefit in this area
E) No reduction in ICU days


Answer: A

Except for Choice A, all others do nor exclude institution of prone positioning in ARDS patients. Actually, prone position should be implemented in early ARDS phase (choice C). Prior to implementing prone position, it should be important to apply all know maneuvers with known benefits including low tidal volume as well as low plateau pressure strategies (choice A), and should be continued while patient is proned. Though prone position does not decrease ICU length of stay, it may decrease total ventilators day, if successful (Choice E). There is a major trial called PROVESA, was published in 2013, showing its benefit on patients who become eligible for it (Choice D).


 Reference: 

 Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159.