Not Prone to Benefit in ARDS: No Other Way to Spin It

Acute respiratory distress syndrome (ARDS) is a relatively common condition that leads to severe hypoxemia and confers considerable mortality secondary to multiorgan dysfunction. Employing lung protection strategies that focus primarily on low tidal volumes and plateau pressures has helped attenuate mortality from ARDS, but nevertheless, mortality remains at about 30%. To examine whether mechanical ventilation in the prone position, which is associated with a positive effect on oxygenation (CMAJ 2008; 178:1153), also lowers ARDS-related mortality, researchers conducted a randomized controlled trial at 25 intensive care units (ICUs) in Italy and Spain.

Investigators randomized 342 ARDS patients with moderate (PaO₂/FIO₂, 100–200 mm Hg) or seve…