Feasibility and Safety of Prone Positioning for Atelectasis in Neurocritical Patients: A Historically Controlled Study

BACKGROUND: Prone positioning is effective for atelectasis but underutilized in neurocritical care due to concerns about neurological safety. This study examined the clinical outcomes and tolerability of prone positioning in a neurocritical care population predominantly comprising patients with encephalitis and status epilepticus. METHODS: In this historically controlled study, neurocritical care patients with atelectasis received either 135-degree semiprone positioning plus standard physiotherapy (intervention) or standard physiotherapy alone (historical control). The cohort primarily included patients with encephalitis or status epilepticus (66%); those with intracerebral hemorrhage or traumatic brain injury were not represented. Outcomes included oxygenation (PaO 2 /FiO 2 ratio), CT-based atelectasis score, and clinical endpoints. RESULTS: Forty-seven patients in the prone group and 50 controls were analyzed. The prone group demonstrated significantly improved PaO 2 /FiO 2 ratios at days 3, 5, and 7 (all P <.05) and greater atelectasis resolution ( P =.002). Mechanical ventilation duration was shorter in the prone group (14.11 vs. 16.82 d, P =.045). ICU stay, mortality, and neurological outcomes were comparable between groups. No serious adverse events attributable to prone positioning occurred. CONCLUSION: Prone positioning was feasible and well-tolerated in this selected neurocritical care cohort, with improved respiratory outcomes and no detectable safety signals. These findings support consideration of prone positioning in similar patient populations, though further research is needed in patients with elevated intracranial pressure risk. In clinical practice, prone positioning can be safely implemented by a trained nursing team using clinical observation in selected neurocritical care patients with stable intracranial pressure.