We found a significant difference in the Pao2:Fio2 ratio after the first prone positioning between ICU survivors and nonsurvivors. The improvement in oxygenation after the first prone positioning was a significant predictor of survival in patients with moderate-to-severe Acute Respiratory Distress Syndrome (ARDS).

The main outcomes were ICU and 28-day mortality. A total of 116 patients receiving prone positioning were included, of whom 45 (38.8%) were ICU survivors.

Although there was no difference in Pao2:Fio2 ratio before the first prone session between ICU survivors and nonsurvivors, ICU survivors had a higher Pao2:Fio2 ratio after prone positioning than nonsurvivors, with significant between-group difference (p < 0.001). Prone responders were defined as an increase in Pao2:Fio2 ratio of greater than or equal to 53.5%. In the multivariate Cox regression analysis, prone responders (hazard ratio, 0.11; 95% CI, 0.05–0.25), immunocompromised condition (hazard ratio, 2.15; 95% CI, 1.15–4.03), and Sequential Organ Failure Assessment score (hazard ratio, 1.16; 95% CI, 1.06–1.27) were significantly associated with 28-day mortality.

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