science

Proning

Proning is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Proning rather than just read about it. In short: Proning or prone positioning is the placement of patients into a prone position so that they are lying on their front. This is used in the treatment of patients in intensive care with acute respiratory distress syndrome (ARDS).

Key takeaways

Proning belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Proning to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Proning from memory before moving on to harder problems.

Reference excerpt

Proning or prone positioning is the placement of patients into a prone position so that they are lying on their front. This is used in the treatment of patients in intensive care with acute respiratory distress syndrome (ARDS). It has been especially tried and studied for patients on ventilators but, during the COVID-19 pandemic, it is being used for patients with oxygen masks and CPAP as an alternative to ventilation.

Intensive care

Prone positioning may be used for people suffering from acute respiratory distress syndrome (ARDS) to improve their breathing. If the patient is undergoing intensive care and sedated then this is a difficult procedure because lifting and turning the unconscious patient requires many staff or special equipment. If they are intubated then care has to be taken to manage the tangle of associated lines and tubes. A 2011 meta-analysis of 48 studies found that there were no negative effects on mortality for patients in intensive care but that a significant reduction in mortality was only found with those patients who were severely ill with ARDS. A 2012 systematic review (updated in 2022) of proning in infants with acute respiratory distress with mechanical ventilation found low certainty evidence that it was effective in improving oxygenation, but did not make definitive recommendations. No adverse effects were found but the risk of sudden infant death syndrome, which is greater in the prone position, necessitates continuous monitoring. A 2014 systematic review of 11 trials found that reduction of the tidal volume of ventilation, in combination with prone positioning, was effective, saving the life of about one additional patient in eleven.

The Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE (LUNG-SAFE) conducted by the European Society of Intensive Care Medicine (ESICM) looked at the use of proning during the study period of 2014. At that time, proning was used for 7% of all ARDS patients and 14% of the most severe cases. The ESICM and Surviving Sepsis Campaign published Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) in 2020. These recommended the use of proning:For mechanically ventilated adults with COVID-19 and moderate to severe ARDS, we suggest prone ventilation for 12 to 16 hours, over no prone ventilation (weak recommendation, low quality evidence). In the COVID-19 pandemic, there is anecdotal evidence in areas such as New York, that prone or reclining posture can be used with oxygen supplied by a mask or continuous positive airway pressure (CPAP) to improve oxygenation and so avoid the need for intubation and ventilation. This especially effective with heavy, obese patients who suffer more on their back in a supine position. In April 2020, the Intensive Care Society issued guidelines for the use of prone positioning with conscious COVID sufferers, recommending that it be tried for all suitable patients.

Mechanisms There are several factors which have been suggested to explain the benefits of this position for ARDS patients. These include

better oxygenation due to the physical effects of the position, reducing the weight of the body on the diaphragm and lungs a reduction in ventilator-associated lung injury (VILI) as the stress and strain on the lungs is reduced improving the effectiveness of the right ventricle of the heart, which pumps blood through the lungs, and so reducing the incidence of fatal cor pulmonale better draining of lung fluids causing a reduction in ventilator-associated pneumonia

See also Positional asphyxia Recovery position Supine position

References

Further reading Penn Proning Guidelines for Critically Ill Patients with COVID-19 – review by University of Pennsylvania Health System

Illustrations

Proning: An adult demonstrating prone positioning in a hospital bed — An adult demonstrating prone positioning in a hospital bed

Worked examples

Example 1 — a first encounter with Proning

Start with the simplest possible case. Write down what Proning claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Proning before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Proning ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Proning

In research: Proning appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Proning in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Proning is common in secondary-school and first-year university syllabi. It links to neighbouring topics Nursing, so understanding it makes those chapters shorter.
In everyday life: Look for Proning outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Proning in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Proning means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Proning out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Proning in simple terms?

Why does Proning matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Proning?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Proning.