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Positional changes and drug interventions in acute respiratory failure

Abstract Acute respiratory failure is often a life‐threatening condition that determines the outcome of acutely ill patients. This review discusses the physiological basis and results of two complementary approaches for the management of such patients: positional changes and drug interventions. In unilateral pulmonary disease locating the healthy lung in a dependent position may improve gas exchange; in bilateral involvement, as occurs in the acute respiratory distress syndrome (ARDS), both the theoretical principles and the observed benefits fully support the use of the prone position. The effect of vasoactive drugs on pulmonary circulation and gas exchange is also reviewed. Selelective vasodilators, such as inhaled nitric oxide and prostacycline‐12, may provide a useful alternative in ARDS.