Clinical Practice

In daily practice the rate of use of prone position is still limited (Table 6.2). The most recent data, not published as yet, from the large observational international Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study found that prone position was used in 7% of ARDS patients and in 14% of those with severe ARDS. It is likely that the risk of complications, like vascular line kinking or withdrawal and endotracheal tube obstruction or removal, are barriers that restraint the caregivers from performing prone positioning more frequently. It should be noted that in the PROSEVA trial, the rate of these complications was not significantly different between the two groups contrary to previous trials. This may reflect the fact that centers that participated in

Table 6.2 Rate of use of prone position in ARDS patients

Values are percentage points in each group this trial have used prone positioning for many years and were able to provide with a safe procedure. Another concern is the pressure sores that occurred more frequently in the prone than in the supine position [57], which should deserve innovative preventive means.