81. RFJC 12 – ARDS Series – PROSEVA

Prone positioning significantly improves survival in patients with severe acute respiratory distress syndrome (ARDS), as demonstrated by the 2013 PROSEVA trial. By transitioning patients with a P/F ratio under 150 to a prone position for at least 16 hours daily, clinicians achieve a 16.8% absolute reduction in 28-day mortality, yielding a number needed to treat of just six. This intervention enhances lung compliance through more uniform distribution of ventilation and reduced mechanical distortion, while simultaneously decreasing pulmonary vascular resistance to offload the right ventricle. Beyond oxygenation benefits, the protocol facilitates earlier liberation from mechanical ventilation and shorter ICU stays. Successful implementation relies on early initiation, consistent adherence to the 16-hour duration, and rigorous safety protocols, establishing prone positioning as a cornerstone of evidence-based critical care for severe respiratory failure.