BoardsBridgeClinical Disease
critical-care
High-impact pattern
Prone Positioning in Severe ARDS
PROSEVA-era protocol: early, prolonged (≥16 h/day) prone ventilation for moderate-severe ARDS
Severe ARDS (Berlin moderate-severe, P/F ≤150 on FiO2 ≥0.6, PEEP ≥5 cmH2O) treated with early, prolonged prone positioning ≥16 consecutive hours/day, continued until PaO2/FiO2 ≥150 sustained supine for ≥4 h.
If you forget
PROSEVA: start early, run long — ≥16 h/day prone in P/F <150 dropped 28-day mortality from 32.8% to 16% (NNT ≈6).
Board trap
Examiner asks: 'When can you stop proning?' Answer: only when PaO2/FiO2 stays ≥150 supine for ≥4 consecutive hours — not on day 7, not after a single good ABG.
Key numbers
- PROSEVA trigger PaO2/FiO2 <150 with FiO2 ≥0.6 + PEEP ≥5 cmH2O
- Prone session ≥16 consecutive hours/day
- PROSEVA 28-day mortality 16% prone vs 32.8% supine (HR 0.39)
- ARDSNet tidal volume 6 mL/kg predicted body weight; plateau ≤30 cmH2O
- Stop prone when PaO2/FiO2 ≥150 sustained supine ≥4 h
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: Proseva Prone 2013 · ARDSNet Lung Protective 2000 · SCCM Ards Peep Titration 2017 · Elscmo VV Ecmo Ards 2024
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: ards-prone · Path: aba.critical-care.respiratory-failure.ards-prone