EXTRACORPOREAL MEMBRANE OXYGENATION, PRONE POSITIONING, AND HIGH POSITIVE END-EXPIRATORY PRESSURE VENTILATION IN ACUTE RESPIRATORY DISTRESS SYNDROME: A NARRATIVE REVIEW

Abstract

Acute Respiratory Distress Syndrome (ARDS) remains one of the leading causes of mortality among critically ill patients despite substantial advances in intensive care management. The syndrome is characterized by severe hypoxemia, diffuse alveolar damage, reduced lung compliance, and impaired gas exchange. Mechanical ventilation remains the cornerstone of treatment; however, inappropriate ventilatory strategies may contribute to ventilator-induced lung injury. Consequently, adjunctive therapies such as prone positioning, high positive end-expiratory pressure (PEEP), and extracorporeal membrane oxygenation (ECMO) have emerged as important interventions aimed at improving oxygenation and survival. This narrative review examines the physiological basis, clinical evidence, advantages, limitations, and current role of ECMO, prone positioning, and high PEEP ventilation in the management of ARDS. Current evidence suggests that prone positioning provides a significant mortality benefit in moderate-to-severe ARDS, while ECMO serves as an effective rescue therapy in refractory hypoxemia. High PEEP ventilation improves alveolar recruitment and oxygenation but demonstrates variable effects on survival. An individualized, multidisciplinary approach integrating these strategies appears essential for optimizing outcomes in severe ARDS.