Piehl and Brown  and Douglas and colleagues  first noted the marked improvement in oxygenation that occurs when ventilating patients with ARDS in the prone position. Their observation has subsequently been reproduced by numerous other groups including the largest single series to date published by Gattinoni and colleagues . These reports indicate that from 50 to 75% of patients have an improvement in their oxygenation on turning prone that is sufficient to allow a reduction in the level of positive end-expiratory pressure (PEEP) and/or the inspired oxygen fraction (FiO2). Contrary to predictions and assertions made by some, none of the studies indicate that the improvement is transient and, in fact, many reports indicate quite the opposite. Chatte and colleagues  and others have noted that some patients maintain most or all of the improvement on returning to the supine position.
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