What is a last-ditch measure to improve oxygenation in ARDS patients?

• A. Prone Positioning
• B. High-Flow Nasal Cannula
• C. Nebulized Bronchodilators
• D. Inhaled Steroids

Answer: (A)

In ARDS, severe hypoxemia often comes from shunting and poor air distribution in the dependent lung regions. Turning the patient onto the stomach improves oxygenation by changing how the lungs are ventilated and perfused. When prone, the heart and mediastinal structures no longer press on the dorsal lung as much, gravity helps recruit now-unperfused areas, and ventilation becomes more evenly distributed. This reduces shunt, improves ventilation–perfusion matching, and can enhance oxygen delivery. It also helps with more uniform lung stress, which may lower the risk of ventilator-induced lung injury during mechanical ventilation. Because it directly targets the main problem—refractory hypoxemia despite optimized PEEP and FiO2—prone positioning is the strongest recognized last-ditch maneuver to boost oxygenation in severe ARDS.

Other options don’t provide the same impact on the underlying oxygenation deficit in ARDS: high-flow nasal cannula can help in milder cases but is usually insufficient as a rescue in severe hypoxemia; nebulized bronchodilators and inhaled steroids don’t rapidly improve oxygenation in this setting and aren’t used as acute rescue measures.