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Introduction <p>Prone positioning is a well-established intervention for improving oxygenation in patients with acute respiratory distress syndrome (ARDS). However, its application in patients with an open abdomen remains controversial due to concerns about hemodynamic instability, wound complications, and technical challenges.</p> Case Presentation <p>We report the case of a 53-year-old morbidly obese female who developed ARDS following emergency laparotomy for a perforated appendix and generalized peritonitis. A right hemicolectomy with damage control surgery was performed, and temporary abdominal closure was achieved using a vacuum-assisted closure (VAC) system. Despite maximal ventilatory support, prone positioning was required to optimize oxygenation. The maneuver was executed under the supervision of intensive care staff, with a surgical team member present to ensure VAC system integrity. Ventilation parameters improved significantly within one hour of pronation, and the patient remained prone for 15&#xa0;h daily without developing abdominal or respiratory complications and later underwent definitive abdominal closure with complete recovery.</p> Conclusions <p>This case highlights the feasibility and potential clinical benefit of prone positioning in patients with an open abdomen managed with negative pressure wound therapy. The VAC system maintained abdominal domain and drainage while minimizing the risk of evisceration. These findings suggest that the presence of an open abdomen should be considered a relative rather than absolute contraindication to prone ventilation in ARDS. Further research is warranted to establish standardized protocols and validate this approach in broader clinical practice.</p>

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Prone Ventilation for Acute Respiratory Distress Syndrome in a Morbidly Obese Patient with Open Abdomen

  • 期刊论文

  • 发表日期：

    2025年11月8日

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  • Manuel Cadena,
  • Arturo Vergara,
  • Luis Felipe Cabrera-Vargas,
  • Esteban Portilla-Rojas,
  • Isabela Arango

摘要

Introduction

Prone positioning is a well-established intervention for improving oxygenation in patients with acute respiratory distress syndrome (ARDS). However, its application in patients with an open abdomen remains controversial due to concerns about hemodynamic instability, wound complications, and technical challenges.

Case Presentation

We report the case of a 53-year-old morbidly obese female who developed ARDS following emergency laparotomy for a perforated appendix and generalized peritonitis. A right hemicolectomy with damage control surgery was performed, and temporary abdominal closure was achieved using a vacuum-assisted closure (VAC) system. Despite maximal ventilatory support, prone positioning was required to optimize oxygenation. The maneuver was executed under the supervision of intensive care staff, with a surgical team member present to ensure VAC system integrity. Ventilation parameters improved significantly within one hour of pronation, and the patient remained prone for 15 h daily without developing abdominal or respiratory complications and later underwent definitive abdominal closure with complete recovery.

Conclusions

This case highlights the feasibility and potential clinical benefit of prone positioning in patients with an open abdomen managed with negative pressure wound therapy. The VAC system maintained abdominal domain and drainage while minimizing the risk of evisceration. These findings suggest that the presence of an open abdomen should be considered a relative rather than absolute contraindication to prone ventilation in ARDS. Further research is warranted to establish standardized protocols and validate this approach in broader clinical practice.