Ding L, et al. - As the ability of prone positioning (PP) to raise PaO₂/FiO₂ (average ratio of arterial oxygen tension to the fraction of inspired oxygen) and decrease mortality in moderate to severe acute respiratory distress syndrome (ARDS) has been suggested in prior investigations, researchers undertook this prospective observational cohort study to investigate if the requirement for intubation in moderate to severe ARDS patients can be averted via early use of PP combined with non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC). Participants included non-intubated moderate to severe ARDS patients. Participants were placed in PP with NIV or with HFNC. Via blood gas analysis, they assessed the efficacy in improving oxygenation with four support methods—HFNC, HFNC+PP, NIV, NIV+PP. The rate of intubation was assessed as the primary outcome. Findings revealed that intubation may be avoided by early application of PP with HFNC, particularly in patients with moderate ARDS and baseline SpO2 > 95%. Experts noted the good tolerability of PP and the observed efficacy of the four support strategies on PaO₂/FiO₂ was HFNC < HFNC+PP ≤ NIV < NIV+PP. Non-suitability of severe ARDS patients was shown as candidates for HFNC/NIV+PP.