Awake prone positioning in a patient with respiratory impairment due to subarachnoid hemorrhage: a case report

Background: Prone positioning has been shown to be an effective rescue strategy in severe acute respiratory distress syndrome and was widely used during the coronavirus disease 2019 pandemic, both in mechanically ventilated and in awake patients. Subarachnoid hemorrhage is often associated with respiratory failure. Prone positioning has been used in brain-injured patients, but concerns relating to neurological complications from intracranial hypertension still remain. Case presentation: We report the case of a 59-year-old Italian patient with subarachnoid hemorrhage who safely underwent awake prone positioning after deterioration of respiratory function. Conclusions: In this report, we show that awake pronation is possible in patients with subarachnoid hemorrhage. However, careful monitoring of Intracranial pressure and clinical examination may be the keys to successful application of this procedure.