Current Practices of Prone Positioning in ARDS Reported by European ICU Clinicians (CUPIDO)—A Cross-Sectional Questionnaire-Based Survey
10 affiliations
- 1Department of Intensive Care Medicine, University Medical Centre Hamburg–Eppendorf, 20246 Hamburg, Germany
- 2Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
- 3Department of Anaesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, 16132 Genoa, Italy
- 4Centre for Medical Sciences (CISMED)–Interdepartmental Centre for Medical Sciences, University of Trento, 38122 Trento, Italy
- 5Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT), Santa Chiara Ospedale, 38122 Trento, Italy
- 6Adult Intensive Care Unit, University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- 7Department of Anaesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anaesthesia & Critical Care Medicine, Medical University Wien, 1090 Vienna, Austria
- 8Department of Anaesthesiology, Rescue and Pain Medicine, Cantonal Hospital St. Gallen, HOCH Health Ostschweiz, 9007 St. Gallen, Switzerland
- 9Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- 10MahidolOxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
Abstract
Background: Prone positioning improves survival in patients with moderate to severe acute respiratory distress syndrome (ARDS), yet its implementation in routine clinical practice remains poorly characterized. We conducted a survey to assess contemporary prone positioning practices and their heterogeneity in the management of ARDS across European intensive care units (ICUs). Methods: A cross-sectional, questionnaire-based survey was conducted among clinicians involved in ARDS management between March and August 2025. The survey was developed by a panel of experts in intensive care medicine and underwent testing for face and content validity prior to dissemination. The questionnaire was distributed through European networks, including the European Society of Intensive Care Medicine (ESICM), the PROtective VEntilation Network (PROVE Network), the European Society of Anaesthesiology and Intensive Care (ESAIC), and national societies. Results: Out of 592 eligible responses, 451 responses were complete and from European clinicians (66.1% male), with the largest contributions being from Italy (28.6%), Germany (18.4%) and Austria (11.5%). Of these, 446 respondents (98.9%) reported performing prone positioning. Initiation thresholds for prone positioning varied, most commonly a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) ≤ 150 mmHg (55.4%), followed by ≤100 mmHg (26.9%), ≤200 mmHg (11.4%), and ≤300 mmHg (1.8%). Full prone positioning was reported as always or often used by 38.6% and 37.7% of participants, whereas semi-prone positioning (7.0% and 21.1%) or lateral positioning (2.5% and 14.8%) was used less often. The duration of prone positioning varied: 47.8% reported 16 h, 17.0% 12 h and 7.8% 8 h per session. Conclusions: Among self-selected clinicians working in European ICUs, prone positioning was commonly reported, though reported practice varied with respect to initiation thresholds, prone positioning strategy and duration. These findings identify specific areas where practice diverges and where current guidance and evidence remain incomplete.
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BibTeX
@article{gleibs2026current,
title = {{Current Practices of Prone Positioning in ARDS Reported by European ICU Clinicians (CUPIDO)—A Cross-Sectional Questionnaire-Based Survey}},
author = {Fabian Gleibs and Markus Haar and Denise Battaglini and Silvia De Rosa and Sergio Lassola and Aneta Volfová and Lise Piquilloud and Stefan Kluge and Marcus J. Schultz and Kevin Roedl},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208082},
url = {https://www.mdpi.com/2077-0383/15/20/8082},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Current Practices of Prone Positioning in ARDS Reported by European ICU Clinicians (CUPIDO)—A Cross-Sectional Questionnaire-Based Survey
AU - Fabian Gleibs
AU - Markus Haar
AU - Denise Battaglini
AU - Silvia De Rosa
AU - Sergio Lassola
AU - Aneta Volfová
AU - Lise Piquilloud
AU - Stefan Kluge
AU - Marcus J. Schultz
AU - Kevin Roedl
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208082
UR - https://www.mdpi.com/2077-0383/15/20/8082
AB - Background: Prone positioning improves survival in patients with moderate to severe acute respiratory distress syndrome (ARDS), yet its implementation in routine clinical practice remains poorly characterized. We conducted a survey to assess contemporary prone positioning practices and their heterogeneity in the management of ARDS across European intensive care units (ICUs). Methods: A cross-sectional, questionnaire-based survey was conducted among clinicians involved in ARDS management between March and August 2025. The survey was developed by a panel of experts in intensive care medicine and underwent testing for face and content validity prior to dissemination. The questionnaire was distributed through European networks, including the European Society of Intensive Care Medicine (ESICM), the PROtective VEntilation Network (PROVE Network), the European Society of Anaesthesiology and Intensive Care (ESAIC), and national societies. Results: Out of 592 eligible responses, 451 responses were complete and from European clinicians (66.1% male), with the largest contributions being from Italy (28.6%), Germany (18.4%) and Austria (11.5%). Of these, 446 respondents (98.9%) reported performing prone positioning. Initiation thresholds for prone positioning varied, most commonly a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) ≤ 150 mmHg (55.4%), followed by ≤100 mmHg (26.9%), ≤200 mmHg (11.4%), and ≤300 mmHg (1.8%). Full prone positioning was reported as always or often used by 38.6% and 37.7% of participants, whereas semi-prone positioning (7.0% and 21.1%) or lateral positioning (2.5% and 14.8%) was used less often. The duration of prone positioning varied: 47.8% reported 16 h, 17.0% 12 h and 7.8% 8 h per session. Conclusions: Among self-selected clinicians working in European ICUs, prone positioning was commonly reported, though reported practice varied with respect to initiation thresholds, prone positioning strategy and duration. These findings identify specific areas where practice diverges and where current guidance and evidence remain incomplete.
SN - 2077-0383
ER -