key: cord-0863781-2nafdcpx authors: Wall, Alanna title: ‘To Prone’ or not ‘To Prone’: that is the grammatical question date: 2021-04-08 journal: Intensive Care Med DOI: 10.1007/s00134-021-06390-6 sha: aeff53a65fd0732b56c6d73997742a331cf04a29 doc_id: 863781 cord_uid: 2nafdcpx nan In 2020, Oxford Languages were unable to name their 'Word of the Year' [1] . They explained that, in an unprecedented year where continuous adaptation was necessary, no single word could truly encompass what has unfolded. Throughout this pandemic, a whole new vocabulary has emerged. The word COVID-19 (coronavirus disease 2019) was only coined in February last year. Since then, we have seen 'mask-shaming' and we have been 'doomscrolling' . We have even heard about 'covidiots' (and hopefully not encountered too many). The medical field, especially, has been subject to these changes and I would like to use this opportunity to formally confirm an addition to our 'post-COVID' terminology. Back in 2013, The NEJM Proseva study reported that placing patients with severe ARDS in prone position for a prolonged period of time significantly decreased mortality [2] . Early on in the pandemic, it was thought, at least anecdotally, that prone positioning could benefit patients with COVID-19 [3] . The European Society of Intensive Care Medicine (ESICM) published guidelines on the management of COVID-19 cases, recommending prone ventilation in mechanically ventilated adults [4] . Indeed, very recently results from a New York City hospital were reported, showing that prone positioning is associated with reduced mortality in COVID-19 patients with moderate to severe ARDS [5] . With results like these, prone positioning has become commonplace in COVID-19 affected intensive therapy units (ITUs). In my ITU, and in many others, we often say that we are going 'to prone' a patient, this is not a new concept. However, in the article mentioned above [5] , they discuss 'prone positioning' . The word prone is never used as an action. I am not able to type the word 'proning' without that disapproving red line appearing underneath. There appears to be a disconnect between the language we use while at work, and the words that we can use on the page. 'Prone' is not the only example of this uncoupling. In fact, it merely scratches the surface of the secret medical lexicon that we all use without permission inside the hospital walls. However, the word has been thrust into the spotlight because of COVID-19. The word prone seemingly only officially exists as an adjective. It comes from the Latin word pronus: 'bent/ leaning forward' . Its relevant meaning is 'lying flat with the front of your body touching the ground' . The word prone does not exist as a verb, despite its widespread use within hospitals. Interestingly, we can pronate a limb (where the inner surface faces down or back), but not the whole body. I think that someone needs to inform the Oxford English Dictionary about our illicit use of the word. I believe we have already accepted the word prone as a verb in the medical field, even if the dictionary has not yet caught up. However, I fear there is some controversy surrounding the opposing action. After listening to different medical professionals instruct me on the plans for our patients in ITU, I find myself asking the question, 'Does one de-prone or un-prone a patient?' . Individual doctors clearly have their preferred word. I am told to 'unprone' one day and to 'deprone' the next. It feels clumsy to flit between the two. But in this grammatical fight, neither side can pull out a dictionary as their chosen weapon, the word simply does not exist. I would like to put an end to this controversy once and for all. The prefix 'un-' is typically related to adjectives. A patient lying face upwards could be 'unprone' . Fortunately, prone is already contrasted with the (much more elegant) word supine. 'Un-' is also not a prefix founded in Latin. It is derived from Proto-Germanic 'andi-' , and is the most prolific of the Old English prefixes. It would be quite unthinkable to combine these two ancient languages. It seems, therefore, that we should use the word 'deprone' to describe the act of returning a patient to the supine position. This would make sense as 'de-' is used as a prefix in Latin, usually meaning 'down, off, away' . In this sense, the prefix has the function of reversing a verb's action, it allows a deed to be undone. I feel that this should persuade some that 'deprone' is the word of choice in this situation. However, I am not a lexicographer. We should contact the Oxford English Dictionary with our concerns. I am sure that they will be in a better position to declare either side victorious. Who knows? This could be Word of the Year 2021. Oxford Languages. Word of the Year 2020 Prone positioning in severe acute respiratory distress syndrome What Doctors on the Front Lines Wish They'd Known a Month Ago. The New York Times Surviving sepsis campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19) Prone positioning in moderate to severe acute respiratory distress syndrome due to COVID-19: a cohort study and analysis of physiology Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.