- Introduction: The acute respiratory distress syndrome (ARDS) was proposed as an acute onset respiratory failure with PaO2/FiO2 ratio <200 (regardless of positive end-expiratory pressure (PEEP) level), bilateral infiltrates on chest X-ray and pulmonary artery occlusion pressure below 18 mmHg. The main therapeutic management of ARDS is based on the concept of protective lung strategy ventilation. Some authors reported about increase in oxygenation in the prone position (PP) in both direct types of ARDS; however, the clinical significance of it still remains questionable. We review and analyze potential clinical benefits of using the prone position in trauma critically ill patients with severe ARDS. Methods: This is an observational, retrospective study provided in university teaching hospital from January 2006 and June 2012. In this study, we retrospectively examined clinical data of 33 trauma and 56 non-trauma critically ill adult patients suffering from severe ARDS and managed by application of prone positioning (PP) during General Intensive Care Unit (GICU) stay. Results: We found no difference in demographic data and in the rate of complications between both study groups after application of PP. The trauma patients with severe acute lung injury demonstrated remarkable improvement in lung compliance (from 18.72 ± 9.52 to 29.285 ± 6.26, p<0.05,) and significant decreases in peak inspiratory pressure (PIP) in the prone position (from 33.48 ± 9.52 cm H2O to 21.06 ± 7.06 cm H2O, p<0.05) The mortality rate was lower in trauma group patients treated by PP (p<0.005) than in non-trauma ICU population. Conclusions: Our study showed clinical benefit by application of PP in the treatment of severe ARDS in posttrauma critically ill patients.