Effects of prone positioning on oxygenation and survival in obese patients with severe acute respiratory distress syndrome: A retrospective cohort study

Acute Respiratory Distress Syndrome (ARDS) poses significant challenges in critically ill patients, particularly for those with obesity, because of compromised respiratory mechanics and increased oxygen consumption. Prone positioning has shown potential benefits in improving oxygenation and respiratory function in patients with ARDS. However, there has been a lack of robust evidence specifically addressing its effects in obese individuals with severe ARDS. A retrospective cohort design was adopted, including obese patients with severe ARDS admitted to the hospital from January 2023 to February 2024. Patients were stratified into the supine group and the prone group, based on their treatment positions. Baseline characteristics, oxygenation parameters, ventilator settings, adverse events, 28-day survival rate, and length of intensive care unit (ICU) stay were compared. The prone group exhibited statistically significant improvements in oxygenation parameters, including arterial blood oxygen tension (PaO2), real-time arterial oxygen saturation (SaO2), pulse oxygen saturation (SpO2), initial inhaled oxygen concentration (FiO2), and P/F ratio. Differences in ventilator settings, adverse events, ICU stay, and 28-day survival rate were also identified. The prone group demonstrated various statistically significant differences in ventilator settings and exhibited a significantly shorter ICU stay and higher 28-day survival rate compared to the supine group. This study provides valuable insights into the effects of prone positioning on oxygenation and survival rate in obese patients with severe ARDS. The findings support the clinical rationale for incorporating prone positioning as a beneficial intervention in this patient population, offering opportunities to enhance oxygenation, respiratory mechanics, and clinical outcomes.