{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:55:51Z","timestamp":1781790951073,"version":"3.54.5"},"reference-count":101,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:p>Body positioning exerts profound physiological effects in critically ill patients, influencing respiratory mechanics, ventilation-perfusion matching, hemodynamics, and overall clinical outcomes. Transitioning from an upright to a recumbent position alters thoracoabdominal pressure relationships, reduces ribcage contribution to tidal ventilation, and shifts ventilatory load to the diaphragm. These changes decrease functional residual capacity and promote airway closure in dependent lung regions, predisposing patients to atelectasis\u2014an effect further amplified by intra-abdominal pathology or diaphragmatic weakness. Positioning also reshapes pulmonary perfusion and ventilation, which impact cardiopulmonary hemodynamics. These physiologic principles translate to important therapeutic applications across disease states. In ARDS, prone positioning improves oxygenation via a number of mechanisms, reduces ventilator-induced lung injury, and confers substantial mortality benefit. Prone position may also improve air flow distribution in COPD and enhance venous return in select cardiac physiologies. Conversely, conditions such as ascites, morbid obesity, and hepatopulmonary syndrome exemplify pathologic interactions between abdominal pressure, lung volumes, and posture, often requiring tailored positioning strategies to optimize respiratory performance. Overall, body positioning represents a potent, underutilized intervention in critical care. Understanding the mechanistic foundations of position-dependent changes in ventilation, perfusion, and pleural pressure can help clinicians strategically leverage positioning to improve patient outcomes across a spectrum of pulmonary and systemic illnesses.<\/jats:p>","DOI":"10.1177\/19433654261454953","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T13:42:00Z","timestamp":1781617320000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Patient Positioning on the Compromised Respiratory System"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-1473","authenticated-orcid":false,"given":"Benjamin Re","family":"Harris","sequence":"first","affiliation":[{"name":"Drs. Harris, Oeckler, and Cortes-Puentes are affiliated with Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Oeckler","sequence":"additional","affiliation":[{"name":"Drs. Harris, Oeckler, and Cortes-Puentes are affiliated with Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Collino","sequence":"additional","affiliation":[{"name":"Dr. Collino is affiliated with Department of Surgical Science, University of Turin, Turin, Italy."},{"name":"Dr. Collino is affiliated with Department of Anesthesia, Intensive Care and Emergency, \u2018Citt\u00e0 della Salute e della Scienza\u2019 University Hospital, Turin, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sritika","family":"Thapa","sequence":"additional","affiliation":[{"name":"Dr. Thapa is affiliated with Yale University, New Haven, Connecticut, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dharani","family":"Narenda","sequence":"additional","affiliation":[{"name":"Dr. Narenda is affiliated with Department of Critical Care Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo A.","family":"Cortes-Puentes","sequence":"additional","affiliation":[{"name":"Drs. Harris, Oeckler, and Cortes-Puentes are affiliated with Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199110000-00010"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1007236"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201412-2224CI"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.6.2019"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1976.41.4.489"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1991.70.3.967"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200504000-00021"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.83.4.643"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/arrd.1984.129.1.101"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199505000-00017"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(69)90071-1"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1991.71.2.620"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1999.86.2.623"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00377.2001"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01289.2006"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aem036"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181cf40c8"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0730-725x(01)00416-7"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00292.2007"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01154.2002"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2010.09.002"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-009-1649-3"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(73)90039-x"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1969.27.6.863"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.59.4.1171"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1966.21.3.749"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201308-1532CI"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1981.51.5.1115"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1980.49.6.946"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04141-7"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc837"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03700-8"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31828a3bea"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-018-0170-9"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1381\/096089205774512546"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202311-2011ST"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-019-0540-9"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214103"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200501-004OC"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06306-w"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-03956-8"},{"key":"e_1_3_2_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0000000000002816"},{"key":"e_1_3_2_44_1","first-page":"1597","article-title":"Predictors of mortality in acute respiratory distress syndrome. Focus on the role of right heart catheterization","volume":"161","author":"Vieillard-Baron A","year":"2000","unstructured":"43.Vieillard-Baron A, , Girou E, , Valente E, et al. Predictors of mortality in acute respiratory distress syndrome. Focus on the role of right heart catheterization. Am J Respir Crit Care Med 2000; 161: 1597\u20131601; doi: 10806161","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_3_2_45_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.71.2_supplement.306"},{"key":"e_1_3_2_46_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197703032960903"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201303-0593OC"},{"key":"e_1_3_2_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000094216.49129.4B"},{"key":"e_1_3_2_49_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1013"},{"key":"e_1_3_2_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04369-x"},{"key":"e_1_3_2_51_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005372"},{"key":"e_1_3_2_52_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901686"},{"key":"e_1_3_2_53_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1744304"},{"key":"e_1_3_2_54_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.0231"},{"key":"e_1_3_2_55_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.0011"},{"key":"e_1_3_2_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-025-07804-5"},{"key":"e_1_3_2_57_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0245-2022"},{"key":"e_1_3_2_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2658-5"},{"key":"e_1_3_2_59_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.3.935"},{"key":"e_1_3_2_60_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00094704"},{"key":"e_1_3_2_61_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00798.2006"},{"key":"e_1_3_2_62_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01336.2007"},{"key":"e_1_3_2_63_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001229"},{"key":"e_1_3_2_64_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2012.123"},{"key":"e_1_3_2_65_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26070"},{"key":"e_1_3_2_66_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00694.2009"},{"key":"e_1_3_2_67_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200801-113OC"},{"key":"e_1_3_2_68_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199609000-00025"},{"key":"e_1_3_2_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000287026.61782.a6"},{"key":"e_1_3_2_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199911000-00011"},{"key":"e_1_3_2_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12655"},{"key":"e_1_3_2_72_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200012000-00041"},{"key":"e_1_3_2_73_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aoa.0000732500.37867.98"},{"key":"e_1_3_2_74_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes349"},{"key":"e_1_3_2_75_1","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-13-31"},{"key":"e_1_3_2_76_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000300"},{"key":"e_1_3_2_77_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04145-3"},{"key":"e_1_3_2_78_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10122182"},{"key":"e_1_3_2_79_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.1998.771003.x"},{"key":"e_1_3_2_80_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000004012"},{"key":"e_1_3_2_81_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.83.5.784"},{"key":"e_1_3_2_82_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.96.1.60"},{"key":"e_1_3_2_83_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-018-0175-4"},{"key":"e_1_3_2_84_1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0b013e3181dc0812"},{"key":"e_1_3_2_85_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0555"},{"key":"e_1_3_2_86_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0708638"},{"key":"e_1_3_2_87_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.11.4.303"},{"key":"e_1_3_2_88_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00587.2019"},{"key":"e_1_3_2_89_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307467"},{"key":"e_1_3_2_90_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004849"},{"key":"e_1_3_2_91_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00619.2001"},{"key":"e_1_3_2_92_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1222445"},{"key":"e_1_3_2_93_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-33036"},{"key":"e_1_3_2_94_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.2001.90.2.405"},{"key":"e_1_3_2_95_1","doi-asserted-by":"publisher","DOI":"10.28982\/josam.900938"},{"key":"e_1_3_2_96_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09194"},{"key":"e_1_3_2_97_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2023201"},{"key":"e_1_3_2_98_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31818f0e68"},{"key":"e_1_3_2_99_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-097X.2009.00885.x"},{"key":"e_1_3_2_100_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-024-02020-3"},{"key":"e_1_3_2_101_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-025-03655-2"},{"key":"e_1_3_2_102_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNN.0b013e3181ecafd4"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261454953","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654261454953","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261454953","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:47:53Z","timestamp":1781790473000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654261454953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":101,"alternative-id":["10.1177\/19433654261454953"],"URL":"https:\/\/doi.org\/10.1177\/19433654261454953","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"article-number":"19433654261454953"}}