Heider J, et al. - In this retrospective observational trial, researchers assessed the feasibility and safety of pressure-supported spontaneous breathing (PS) during prolonged prone positioning (PP) in acute respiratory distress syndrome (ARDS) patients sedated with inhaled sevoflurane. Overall, in 62 patients who had a median of four prone episodes during treatment, they observed 4339 h of prone positioning. During volatile sedation with sevoflurane, pressure-supported spontaneous breathing can be achieved during prolonged prone positioning in intubated ARDS patients with or without extracorporeal membrane oxygenation (ECMO). This finding may provide a basis for questioning the latest ARDS therapy dogma. Before it can be routinely applied, the concept must be further investigated and compared to controlled ventilation with regard to driving pressure, lung-protective parameters, muscle weakness and mortality.