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We thank Dr Baldi et al for their correspondence regarding our clinical overview of prone positioning in ARDS.1Scholten E.L. Beitler J.R. Prisk G.K. Malhotra A. Treatment of acute respiratory distress syndrome with prone positioning.Chest. 2017; 151: 215-224Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar Experienced centers treating ARDS with prone positioning and complementary lung-protective strategies can achieve significant reductions in mortality.2Beitler J.R. Shaefi S. Montesi S.B. et al.Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis.Intensive Care Med. 2014; 40: 332-341Crossref PubMed Scopus (140) Google Scholar, 3Guerin C. Reignier J. Richard J.C. et al.Prone positioning in severe acute respiratory distress syndrome.N Engl J Med. 2013; 368: 2159-2168Crossref PubMed Scopus (2265) Google Scholar However, in the modern era, prone positioning is likely still underused in patients with severe ARDS.4Gattinoni L. Van Haren F. Larsson A. Mcauley D.F. Ranieri M. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries.JAMA. 2016; 315: 788-800Crossref PubMed Scopus (2651) Google Scholar Baldi et al’s practical and helpful safety mnemonic, in addition to online video resources, will be helpful for lower-volume centers looking to increase implementation of prone positioning.3Guerin C. Reignier J. Richard J.C. et al.Prone positioning in severe acute respiratory distress syndrome.N Engl J Med. 2013; 368: 2159-2168Crossref PubMed Scopus (2265) Google Scholar Prone Positioning?: Remember ABCDEFGCHESTVol. 151Issue 5PreviewWe read with interest the article “Treatment of ARDS With Prone Positioning” wherein the authors summarize the physiological principles, clinical evidence, and practical application of prone position ventilation in ARDS.1 Prone positioning entails an increased risk of complications, including pressure sores, endotracheal tube displacement, loss of venous access, and others.2 Girard et al3 compared the incidence and severity of pressure ulcers in the participants of the Proning Severe ARDS Patients (PROSEVA) trial4 and highlighted the need for active prevention of pressure sores in patients who are put in a prone position. Full-Text PDF Treatment of ARDS With Prone PositioningCHESTVol. 151Issue 1PreviewProne positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning. Full-Text PDF