II. Indications
- Prevention of Respiratory Failure
- Awake, cooperative patient self-performs position changes to maximize lung recruitment
- Ehrmann (2021) Lancet Respir Med 9(12):1387-95+PMID:34425070 [PubMed]
-
Respiratory Failure (Intubated patient with, for example, ARDS or Severe Covid Pneumonia)
- Mechanical Ventilator FIO2 >0.6
- P/F Ratio <150
- where P/F Ratio = PaO2 / FIO2
- where PaO2 = arterial PO2 (from Arterial Blood Gas)
- where FIO2 = fraction of inspired oxygen (ranging from 0.3 for 30% to 1.0 for 100%)
III. Physiology
- Lung recruitment improves in prone position (or on side or upright) compared with supine position
IV. Technique: Awake, Cooperative Patient
- Direct patient to roll to prone position and other positions for as long as they are comfortable
- Positions
- Prone position (peferred)
- Left lateral decubitus or right lateral decubitus positions
- Sitting Upright
V. Technique: Intubated Patient
- Precautions
- Much more difficult in obese patients (unless on rotational bed)
- Perform procedures before Proning (patient access is difficult in prone position)
- Transthoracic Echocardiogram
- Central venous catheters
- Arterial catheters
- Portable XRays
- Expect the Oxygen Saturations to drop precipitously on initial position change
- In Covid19 patients, Oxygen Saturations would drop to 70% for first 15 minutes after change
- Approach
- Prone for 16 hours, supine for 8 hours per day