LAUSR

Prone positioning (PP) during invasivemechanical ventilazione has been demonstrated to improve respiratory mechanics and gas exchange. Prone positioning reduces mortality of most severe acute respiratory distress syndrome patients. In theory, these benefits should apply also to nonintubated patients, in whom PP may improve oxygenation while delaying or even avoiding the need for intubation. Reports of the application of PP in spontaneously breathing, nonintubated adult patients, before the COVID era, are limited to few case reports. During the last 14 months, PP has been largely used in all intensive care units (ICUs) to treat patients with COVID-19 acute respiratory failure. Even the use of awakePP, outside ICUs, has been investigated by several authors during theCOVID-19 pandemic.Albeit clear evidence on its impact of outcome is missing in awake patients, PP is extensively usedworldwidewith several trials ongoing. Although the respiratory benefits of PP in acute respiratory distress syndrome have been accepted, the concurrent complications could be undervalued. González-Seguel and colleagues performed a scoping review about PP complications, including 41 documents from121 eligible studies. They identifiedmore than 40 individual adverse events, and the highest pooled occurrence rates were that of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilation-associated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies to reduce PP complications include alternate face rotation, repositioning every 2 hours, and the use of pillows under the chest and pelvis. The reported