PRONE positioning is a simple method to improve oxygenation in ventilated patients with acute respiratory distress syndrome (ARDS). Potential explanations are reduction of ventilation/perfusion mismatch, a more homogeneous distribution of transpulmonary pressure along the ventral-to-dorsal axis, and recruitment of nonaerated dorsal lung regions of the lung, with an increase in lung volume. Many of these mechanisms could also apply to awake patients with ARDS by COVID-19.

Here, we present an image (fig. 1) from a computed tomography performed in a 71-yr-old woman with ARDS from COVID-19 in both supine and prone positioning during awake spontaneous ventilation. Arterial blood gas analysis in the supine position with high-flow nasal cannula oxygen therapy (50% concentration; flow rate, 50 l/min) showed Pao2/fractional inspired oxygen tension (Fio2) of 130, with an improvement in...

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