Prone Positioning Use Surged During Pandemic, Declined Post-COVID

Acute respiratory distress syndrome (ARDS) remains a formidable challenge in critical care, with mortality rates for severe cases exceeding 45% [1, 2]. While lung-protective ventilation is a cornerstone of management [3], prone positioning has been established as a key adjunctive therapy that improves oxygenation and reduces mortality in patients with moderate-to-severe ARDS, particularly when initiated early for at least 12 hours daily [4, 5, 6, 7]. Evidence for its benefit is robust, with one meta-analysis in pediatric patients showing a significantly lower risk of death (risk ratio 0.67, 95% confidence interval 0.57-0.79) [8]. Despite this strong evidence base, the adoption of proning in routine clinical practice has been historically inconsistent [9, 1], creating a gap between guidelines and bedside care. A new study provides a detailed look at how proning utilization shifted in North American intensive care units before, during, and after the COVID-19 pandemic.