Download PDF. Patients are placed in the prone position for 16 to 18 hours and then placed in the supine position (lying horizontally with the face and torso facing up) for 6 to 8 hours if the oxygen levels are able to tolerate it. Prone positioning as a therapeutic intervention for ARDS has been studied for decades, with inconclusive results regarding the benefits to patients. However, the physiological mechanisms causing respiratory function improvement as well as the real clinical benefit are not yet fully understood. Prone positioning is required for surgical procedures that involve the posterior aspect of a patient. The purpose of this Continuing Professional Development module is to provide information needed to prepare for and clinically manage a patient in the prone position. This JAMA Patient Page describes the technique of prone positioning during acute respiratory distress syndrome (ARDS), the possible benefits of prone positioning for patients hospitalized with COVID-19, and the risks involved. Benefits of prone positioning for mechanically ventilated patients. Share. The prone position makes it difficult to get up and move off line or be mobile in a hurry. Prone positioning (also known as ‘proning’, ‘prone manoeuvre’ or ‘prone ventilation’) refers to mechanical ventilation with patients positioned in prone position in contrast of standard supine (flat or semi-recumbent) position. An article in the journal Anesthesiology describes the effects of prone positioning on oesophageal pressures in mechanically ventilated patients. While all of these benefits would be anticipated with awake proning of COVID-19 patients—and one previous study showed improved oxygenation with awake prone positioning in COVID-19—we did not find improved S/F ratios during the first 48 hours of hospitalization in our cohort . Joseph Hadaya, MD; Peyman Benharash, MD. Prone positioning also promotes pulmonary toileting and alveoli opening, and it has been associated with a decrease in ventilator-induced acute lung injury. In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome (ARDS) and this manoeuvre is now considered a simple and safe method to improve oxygenation. 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