The aim of this paper is to review the evidence for the use of body positioning to improve oxygenation in the mechanically ventilated patient with acute respiratory failure. The emphasis is placed on research evidence for both benefits and risks associated with the use of common body positions in this patient population. Increased regional ventilation under the influence of gravity with an overall improvement in the ventilation/perfusion ratio appears to be the main mechanism of position-induced improvement in oxygenation. Strong evidence exists for positioning with the affected lung superior in acute respiratory failure due to unilateral lung disease. Haemodynamic risks, however, have been shown to prone positioning for improving oxygenation in patients with acute respiratory failure. No major complications arising from the prone position have been reported. Randomised clinical trials on the effects of upright and semi-recumbent positions are needed. Physical therapists prescribe body positioning in patients with acute respiratory failure based on knowledge derived from physiological studies in the laboratory. The application of Sackett's rules of evidence in clinical studies has supported some of these physiological bases, identified areas for further research and highlighted their utility in distinguishing the relative strengths of scientific evidence.

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A brief summary and a critical assessment of this review may be available at DARE