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J Burn Care Res. 2018 Apr 20;39(3):471-475. doi: 10.1097/BCR.0000000000000601.

Prone Positioning of the Burn Patient With Acute Respiratory Distress Syndrome: A Review of the Evidence and Practical Considerations.

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Department of Anesthesiology and Critical Care Medicine, Postgraduate Critical Care Residency for Physician Assistants, Johns Hopkins Medicine, Baltimore, MD.
Johns Hopkins Burn Center, Johns Hopkins Medicine, Baltimore, MD.
Clinical Dietitian Specialist III, Johns Hopkins Bayview Medical Center, Surgical ICU, Burn ICU, Burn Wound Unit, Johns Hopkins Medicine, Baltimore, MD.
Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Johns Hopkins Burn Center, Bayview Campus, Baltimore, MD.


Acute respiratory distress syndrome (ARDS) is a common sequela of severe burns and inhalation injury. The massive inflammatory reaction that follows deep burn injury, compounded by episodes of sepsis and organ dysfunction, predisposes patients to the development of ARDS. Prone positioning as a means of improving gas exchange has shown benefit in refractory cases of ARDS, but it is not well described in the burn population. We present a case report of a patient with severe ARDS who underwent prone positioning, review the relevant literature, and provide a discussion of practical concerns.

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