Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?  

Aggressive PEEP titration is a loaded term. Do these patients need higher PEEPs? Yes, if they are recruitable. You need to understand the lung mechanics and the concept of stress and strain to make sure that you are optimizing the inflation pressure these lungs are exposed to. This can be achieved b...