Prone positioning will be performed according to the current guidelines. Particularly, face and limbs will be placed according to the swimmer position, ensuring the face position in the direction of ventilator and limbs (one arm above head and opposite arm at side) positioned as to prevent abnormal extension or flexion against the shoulders and elbows. Patients will lie on low air loss pressure mattresses, thus avoiding the utilization of any thoraco-pelvic supports, which are not recommended. Electromyography (EMG) will be performed to evaluate the occurrence of brachial plexus injury (BPI).
The goal of this prospective observational study is to estimate the prevalence of brachial plexus injury after prone positioning in patients with ARDS and to evaluate the safety of swimmer position. The main questions it aims to answer are:~Could arm positioning during pronation play a role in the development of any nerve injury at the brachial plexus level?~Is swimmer position safe when adopted during prone positioning?~Participants will be studied at selective time points using EMG assessment.