Which therapy has been shown to improve outcomes in severe ARDS?

Prone positioning has been shown to improve outcomes in patients with severe Acute Respiratory Distress Syndrome (ARDS) by enhancing lung mechanics and promoting better gas exchange. When patients are placed in the prone position, the distribution of ventilation and perfusion can improve, reducing shunting and improving oxygenation. This positioning helps to open collapsed alveoli in the dorsal parts of the lungs, which are more prone to atelectasis in ARDS. Additionally, pronation can decrease the pressure on the lungs from the heart and mediastinal structures, facilitating better lung expansion and potentially improving lung compliance.

Research has demonstrated that prone positioning significantly reduces mortality rates among patients with severe ARDS, especially when applied for extended periods. It is particularly effective in improving oxygenation measurements, such as PaO2/FiO2 ratios, without requiring an increase in supplemental oxygen or other invasive measures.

The other therapies listed may have roles in managing ARDS but have not been shown to provide the same consistent benefit in improving outcomes as prone positioning in severe cases. For instance, while high-frequency oscillatory ventilation may benefit certain patients, its effectiveness compared to traditional methods remains debated. Supine positioning is the standard and may not take full advantage of lung mechanics in ARDS patients, while