If the patient’s disease is primarily in the lower lobes (based on CXR or CT findings), a trial of prone positioning for 2–6 hours should be performed.31 If the patient’s gas exchange improves, continue the proning therapy. A recent study of patients with moderate to severe ARDS (P:F <150) demonstrated a mortality benefit to proning for 16 hours/day.32 This is best done by an experienced team able to avoid tube/line dislodgment during the proning maneuver, and may not be practical in the deployed or austere setting. The EKG electrodes are placed on the patient’s back and the eyes are taped shut. This approach is best implemented in the setting of a proning protocol which includes indications and contraindications, a pre-proning checklist, and a description of nursing care of the proned patient.