* * *

*What is Prone Positioning? *

Prone positioning, or ?proning? is a new form of treatment sometimes
used to support mechanically ventilated patients with ARDS who
require high concentrations of inspired oygen! "o initiate prone
positioning medical staff turn an ARDS patient face down from his or
her #ac$ %supine position&! "hereafter, the patient may #e turned from
one position to the other as often as three times a day until the
requirement for a high concentration of inspired oygen resolves!
*'ow Does Prone Positioning 'elp? *
(ne important goal for the supportive treatment of patients with ARDS
is to maintain adequate oygenation of the #lood #y the in)ured lungs
P(* greater than +, while avoiding a potentially toic concentration of
inspired oygen %greater than +,-.,/ oygen&!
Prone positioning often improves oygenation in patients who have
ARDS #y shifting #lood flow to regions of the lung that are less
severely in)ured and thus #etter aerated!
With the proper equipment, proning may also allow the a#domen
to epand more and facilitates #etter movement of the diaphragm!
*0s Proning an 1ffective "echnique? *
Researchers have not reached a consensus as to whether prone
positioning improves the survival rate among ARDS patients! 'owever,
most research has shown that proning does improve oygenation,
significantly in some cases! 2nfortunately, not all ARDS patients
respond favora#ly to prone positioning, and the #enefit sometimes
wanes over time!
*Should 1very ARDS Patient 3e Proned? *
4ot all patients are in a physical condition that permits such movement
(f the #ody!
Patients
whose heads cannot #e supported in a face-down
Position,
those who have circulation pro#lems,
very large patients
Some in)uries, such as a #ro$en pelvis, ri# fratures for eample, and
other conditions as determined #y the
attending physician may also disqualify a patient from #eing proned!
1ven advocates of the technique do not typically recommend proning
as a
?routine? intervention for ARDS patients! 3ecause there is a small ris$
of complications associated with turning critically ill patients, most
researchers and advocates recommend the technique #e reserved for
those
patients with severe hypoemia, or low #lood oygen levels!
*'ow is Proning Performed? *
Proning is performed #y a specific procedure that generally involves
several critical care staff and is usually overseen #y the attending
physician! Specific training for critical care staff is availa#le!
*'ow 5ong Should a Patient 3e Proned? *
"hough availa#le research ma$es no specific recommendations, + or
more hours a day, for as long as 6, days, appears typical in clinical
studies
and reported practice!
*What are the Ris$s of Proning? *
1ven with proper equipment, physically flipping over a critically ill
patient has ris$s, particularly since the patient will #e hoo$ed up to
many wires and tu#es! Possi#le pro#lems include
unintended etu#ation %tu#es coming out&,
airway o#struction,
and difficulties coordinating the ventilator!
Some patients may require increased sedation and muscle
relaants, may eperience facial swelling, and may develop ?pressure
sores? on the weight-#earing parts of the #ody, such as the $nees and
chest!
"hough there are ris$s, critical care staffs that attempt to prone an
ARDS patient are trained to follow esta#lished procedures to ensure
safety! "he physical difficulties of proning have #een the traditional
#arrier to its use! Progress through equipment innovations such as the
7ollman Prone Positioner %8www!vollman!com&8, a lightweight,
cushioned
frame that straps to the front of the patient #efore turning, has helped
to minimi9e the ris$s associated with moving patients and maintaining
them in the prone position for several hours at a time!


References
Prone Positioning of Patients With Acute Respiratory Distress
Syndrome:
A Systematic Review,
;American <ournal of =ritical =are;, 4ovem#er 6>>>, 7ol ?, 4o! +
1ffect of Prone Positioning on the Survival of Patients with Acute
Respiratory @ailure, ;4ew 1ngland <ournal of Aedicine;, August *B,
*,,6,
7ol BCD:D+?-D.B 4o! ?
"he Acute Respiratory Distress Syndrome, Aechanical 7entilation, and
the
Prone Position, ;4ew 1ngland <ournal of Aedicine;, August *B, *,,6, 7ol
BCD:D+?-D.B 4o! ?
7ollman Prone Positioner, Policy and Procedure,
8http:;;www!vollman!com 8
=omputer-Supported =ontinuous Aial Rotation "herapy 0n Prone
Position
@or =omple Polytrauma Patients With ARDS, Elini$um der
Philipps-2niversitFt Aar#urg,
8www!med!uni-mar#urg!de;unfchir;pro)e$te;p8intmed86!html 8
"eamwor$, "echnology Save 5ife of 1pectant @ather, ;=ommunity
Spirit,;
=ommunity 'ospitals @oundation of 0ndiana!