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Prone positioning (also known as proning, prone maneuver, or prone ventilation) is mechanical ventilation with patients in a prone position as opposed to the standard supine (flat or semi-recumbent) position.

Over 30 years ago, the prone position was proposed as a way to improve arterial oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). The effects of prone positioning on gas exchange are caused by a redistribution of lung ventilation and perfusion. Indeed, the gravitational field of the earth influences regional lung ventilation and pulmonary blood flow in any body position.

When we use prone positioning on a patient, we reverse the vector of this gravitational force, which has significant implications for inflation and perfusion distribution. As a secondary and less important effect, prone positioning promotes postural drainage of tracheobronchial tree secretions, potentially improving regional lung ventilation.

Dr. Sai Praveen Haranath discusses everything you need to know about the importance of proning and how its done and its physiological effects.