Prone Positioning Flashcards
What is the point of Prone Positioning
Prone positioning is used to improve oxygenation by creating a better V/Q mismatch
What is the theory behind prone positioning
The thought behind this is that when you are lying supine all of the perfusion will go to the posterior chest and ventilation will go towards the anterior chest
When the patient has been pronned this will be switched where ventilation moves to the posterior chest and perfusion goes to anterior chest
You will have a period of time when this is happening where perfusion and ventilation will be matched in the same spot and there will be good V/Q matching
Where does prone postioning help
There has not been strong evidence that prone positioning will help in long term outcomes but it may help with severe ARDS
Inclusion Criteria
Ventilated patients
Acute lung injury where there is V/Q mismatching
Cardiogenic pulmonary edema
ARDS
Pneumonia
Pulmonary embolism
Clinical Criteria
FiO2 > 0.60 with optimized oxygen delivery
This tends to be a last choice therapy
Absolute Exclusion Criteria
Acute Bleeding
Spinal instability
Pregnancy in the third trimester
Increased ICP
Traction
Weight > 136 kg
Unstable sternum (open heart surgery)
Ventricular assist device
Intraortic balloon pump
Open abdominal wound
Open chest
Partial Liquid Ventilation
Relative Exclusion Criteria
Multiple trauma
Continuous renal replacement therapy
Temporary pacemaker
Hemodynamic instability
Large abdomen
Gross ascites
Pronning Prepartion
Airway secured and vent tubing to side away from vent-You do not always have to turn towards the vent but that is the recommended
Suctioning of mouth and ETT
Saturation monitor is on
Lines/tubes are positioned
Ensure adequate sedation
Record the baseline hemodynamic profile
Procedure
Use prone positioning equipment to assist the turn (e.g. Volman Prone Positioner); turn towards vent
Assess tolerance and airway
Position patient
Recalibrate the monitoring lines
Perform ABG and hemodynamic profile
Continue to assess tolerance, assess for complications and provide sedation as needed
How to Position the Patient
Reverse trendelenburg, 30 degrees if possible
This will limit aspiration
Use pillows/positioning devices to maximize diaphragmatic excursion
According to AHS How Long Should We Prone
AHS prones for 3 hours; supine 1 hour
Discontinuation of Proning
FiO2 < 0.60
(Kacmarek says FiO2 £ 0.40 and PEEP £ 8 with PaO2 ≥ 60)
Deterioration of patient status related to prone position
Positioning demonstrates no improvement in patient status or becomes no longer beneficial
Limitations/Cautions
Labour intensive
May result in deterioration of the patient’s cardiopulmonary status (can try to medically manage before returning supine)
Complications of skin breakdown and eye injury*High risk of orbital compression
