The Impact Of Prone Positioning As A Respiratory Therapy Protocol In ICU Patients, Scoping Review

Abstract

Background:
Prone positioning (PP) has emerged as a valuable non-pharmacological intervention to improve oxygenation in ICU patients with acute respiratory distress syndrome (ARDS), particularly during the COVID-19 pandemic. Despite evidence supporting its use, variability persists regarding its application, timing, and patient selection.

Objective:
To map and synthesize current literature on the efficacy and safety of prone positioning as a respiratory therapy protocol for ICU patients with acute respiratory failure.

Methods:
A scoping review was conducted following the PRISMA-ScR framework. Comprehensive searches of PubMed, Cochrane Library, Scopus, Embase, and Google Scholar were performed through 2025

Results:
Fifteen studies met the inclusion criteria, encompassing RCTs, cohort, observational, and systematic reviews/meta-analyses. Most studies reported a consistent improvement in oxygenation (e.g., PaO₂/FiO₂ ratios) with prone positioning, especially in COVID-19-related ARDS. Some evidence indicated reduced intubation rates in awake, non-intubated patients, although effects on mortality and ICU length of stay were inconclusive or mixed. Complications were generally minor, such as facial edema or transient hemodynamic shifts. Considerable heterogeneity in protocols was observed regarding session duration, frequency, and patient selection.

Conclusion:
Prone positioning is a beneficial and generally safe adjunctive therapy to enhance oxygenation in ICU patients with ARDS, particularly among moderate to severe cases and those with COVID-19. However, its effects on mortality and ICU stay remain uncertain due to heterogeneity in study protocols and designs. Future large-scale, standardized studies are needed to clarify optimal protocols and assess long-term outcomes. Clinical guidelines should emphasize staff training and standardization to maximize the benefits and minimize risks associated with prone positioning in ICU settings.