Posición prono en respiración espontánea: una lección más del COVID-19

During the pandemic, various strategies were implemented to avoid intubation and invasive mechanical ventilation. The prone position has clear beneficial effects in improving oxygenation by various mechanisms while generating haemodynamic changes that can optimize the function of the right ventricle. The evidence of prone position in patients with acute respiratory distress syndrome on invasive mechanical ventilation is overwhelming and makes it necessary to consider it in the first 24 hours in patients with PaO(2) / FiO(2) ≤ 150 mmHg. The prone position in spontaneous breathing can improve oxygenation in patients with respiratory failure and if implemented through a protocol that includes adequate selection of patients it can avoid intubation of patients in respiratory failure. This review summarizes the historical antecedents, the physiological bases of the prone position in the awake patient, as well as the evidence that evaluates its application in the patient with COVID-19 while summarizing the protocol and the experience of a centre that uses this strategy as a proposal for multicentre studies.