Prone Positioning

In a documented clinical case, prone positioning raised PaO2 from approximately 60 mmHg to 250 mmHg within minutes. Prone positioning corrects oxygenation deficits by redistributing blood flow to well-aerated anterior lung segments away from fluid-filled posterior ones. Supine positioning causes blood to preferentially flow to posterior lung segments filled with inflammatory fluid, producing severe ventilation-perfusion mismatch. Awake, spontaneously breathing COVID-19 patients should be actively coached to self-prone rather than being treated as passive recipients of the technique. Prone positioning is only effective in patients with alveolar fluid (airspace disease) and is not expected to help pure bronchitis. Prone positioning can prevent intubation while buying time for systemic inflammation to resolve.