RT Journal
A1 Russell JA
T1 PRone positioning in patients with acute respiratory distress syndrome
JF JAMA
JO JAMA
YR 2010
FD March 3
VO 303
IS 9
SP 832
OP 833
DO 10.1001/jama.2010.183
UL http://dx.doi.org/10.1001/jama.2010.183
AB 
Shock and hemodynamic instability make prone positioning more difficult and potentially less safe. Furthermore, hemodynamic alterations and vasoactive agents (such as α- and β-adrenergic agents used clinically, including norepinephrine, dopamine, and dobutamine) can change perfusion distribution in the lung, alter gas exchange, and worsen oxygenation. Thus, over time a patient could move out of a state of being ineligible for the trial, and could also move from a classification of moderate to severe hypoxemia, with no change in the underlying ARDS pathology.