Feasibility of Prone Positioning in Patients With Obesity and Acute Respiratory Distress Syndrome.

Caleb Lee; Alexandra Paxitzis; Omar M Mehkri; Lynne Kokoczka; Shuaiqi Huang; Xiaofeng Wang; Shewit Giovanni; Eduardo Mireles-Cabodevila; Sudhir Krishnan; Abhijit Duggal

doi:10.4037/ajcc2026929

PubMed · 42676144

Feasibility of Prone Positioning in Patients With Obesity and Acute Respiratory Distress Syndrome.

Caleb Lee·Alexandra Paxitzis·Omar M Mehkri·Lynne Kokoczka·Shuaiqi Huang·Xiaofeng Wang·Shewit Giovanni·Eduardo Mireles-Cabodevila·Sudhir Krishnan·Abhijit Duggal

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Abstract

BACKGROUND: Prone positioning in patients with obesity remains uncommon because of concerns about feasibility, safety, and efficacy. OBJECTIVE: To evaluate the feasibility, safety, and clinical outcomes of manual prone positioning in patients with acute respiratory distress syndrome (ARDS) across different classes of obesity. METHODS: This was a retrospective cohort study involving patients with ARDS who underwent manual prone positioning across 15 hospitals between April 2014 and July 2024. Patients were stratified into 5 groups based on body mass index. Standardized prone positioning protocols were followed across institutions. RESULTS: A total of 1448 patients with ARDS underwent prone positioning. Across all obesity categories, prone positioning was associated with shorter intensive care unit and hospital stays, improved oxygenation, and better clinical outcomes. Notably, patients with class III obesity showed the greatest increase in gas exchange efficiency, with a 37% improvement in ratio of Pao2 to fraction of inspired oxygen, compared with 28% in patients with normal weight (P < .05). Complication rates were low across all groups. CONCLUSIONS: Prone positioning is feasible and safe in patients with ARDS across all obesity classes. Patients with class III obesity showed the greatest improvements in oxygenation. Future prospective studies should further explore the long-term impact of prone positioning in patients with class III obesity to refine clinical guidelines and optimize care.

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Humans Prone Position Respiratory Distress Syndrome Retrospective Studies Obesity Feasibility Studies Female Male Middle Aged Intensive Care Units Patient Positioning Aged Body Mass Index Length of Stay Journal Article

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Caleb Lee, Alexandra Paxitzis, Omar M Mehkri, Lynne Kokoczka, Shuaiqi Huang, Xiaofeng Wang, Shewit Giovanni, Eduardo Mireles-Cabodevila, Sudhir Krishnan, Abhijit Duggal. 2026-09-01. Feasibility of Prone Positioning in Patients With Obesity and Acute Respiratory Distress Syndrome.. https://doi.org/10.4037/ajcc2026929

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Journal Article resource Aged subject Body Mass Index subject Feasibility Studies subject Female subject Humans subject Intensive Care Units subject Journal Article subject Length of Stay subject Male subject Middle Aged subject Obesity subject

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