{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T12:35:27Z","timestamp":1780144527727,"version":"3.54.0"},"reference-count":93,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007437","name":"TrygFonden","doi-asserted-by":"publisher","award":["101390"],"award-info":[{"award-number":["101390"]}],"id":[{"id":"10.13039\/501100007437","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007437","name":"TrygFonden","doi-asserted-by":"publisher","award":["20045"],"award-info":[{"award-number":["20045"]}],"id":[{"id":"10.13039\/501100007437","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Experimental Physiology"],"published-print":{"date-parts":[[2022,7]]},"abstract":"New Findings<\/jats:title>\nWhat is the topic of this review?<\/jats:bold><\/jats:p>\nThe use of proning for improving pulmonary gas exchange in critically ill patients.<\/jats:p><\/jats:list-item>\nWhat advances does it highlight?<\/jats:bold><\/jats:p>\nProning places the lung in its \u2018natural\u2019 posture, and thus optimises the ventilation\u2010perfusion distribution, which enables lung protective ventilation and the alleviation of potentially life\u2010threatening hypoxaemia in COVID\u201019 and other types of critical illness with respiratory failure.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>Abstract<\/jats:title>The survival benefit of proning patients with acute respiratory distress syndrome (ARDS) is well established and has recently been found to improve pulmonary gas exchange in patients with COVID\u201019\u2010associated ARDS (CARDS). This review outlines the physiological implications of transitioning from supine to prone on alveolar ventilation\u2010perfusion () relationships during spontaneous breathing and during general anaesthesia in the healthy state, as well as during invasive mechanical ventilation in patients with ARDS and CARDS. Spontaneously breathing, awake healthy individuals maintain a small vertical (ventral\u2010to\u2010dorsal) ratio gradient in the supine position, which is largely neutralised in the prone position, mainly through redistribution of perfusion. In anaesthetised and mechanically ventilated healthy individuals, a vertical ratio gradient is present in both postures, but with better matching in the prone position. In ARDS and CARDS, the vertical ratio gradient in the supine position becomes larger, with intrapulmonary shunting in gravitationally dependent lung regions due to compression atelectasis of the dorsal lung. This is counteracted by proning, mainly through a more homogeneous distribution of ventilation combined with a largely unaffected high perfusion dorsally, and a consequent substantial improvement in arterial oxygenation. The data regarding proning as a therapy in patients with CARDS is still limited and whether the associated improvement in arterial oxygenation translates to a survival benefit remains unknown. Proning is nonetheless an attractive and lung protective manoeuvre with the potential benefit of improving life\u2010threatening hypoxaemia in patients with ARDS and CARDS.<\/jats:p><\/jats:sec>","DOI":"10.1113\/ep089405","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T19:28:31Z","timestamp":1625858911000},"page":"759-770","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Therapeutic benefits of proning to improve pulmonary gas exchange in severe respiratory failure: focus on fundamentals of physiology"],"prefix":"10.1113","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-9506","authenticated-orcid":false,"given":"Ronan M. 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