Proning ARDs patients

[catamounts303]

Hi everyone,

Our ICU is starting to get really aggressive in identifying and aggressively treating ARDS patients much sooner. We have used the huge KCI beds that rotate with much success. With that said we want to try proning more patients sooner and much more often. The KCI just isn't feasible all the time.

I was wondering is if anyone could comment/walk me through as to how they prone patients on the bed. Ive heard it can be done safely with a log roll and would be greatful to hear how you do it.

Thank you all in advance.

[Chaserr]

Saw proning the first time last week. Make sure you have respiratory to secure the airway and do a good ol' log roll. It was amazing to see how much the patient responded to the new position.

[stormymemphis]

We use Rotoprone as well. While it does greatly improve oxygenation, I can't say with any confidence that it actually increasesa patient's chance of survival. Honestly, in the last 5 years, I have only seen one patient survive ARDS with help from the Rotoprone. This has been the worst flu season I have ever seen, and we have been using the Rotoprones fairly regularly this season. They have been so popular throughout the city (of Memphis) that we have actually had to place our patients on waiting lists for get a bed. Just last week, we had a patient wait for a week before we received a Rotoprone to place her on.

[XYRNMN]

We use the Rotoprone as well, but there are times one isn't available right away so yeah we prone on the regular bed.

Part of it is we gatch the bed a bit so that the top half is at about 20° and the lower half has been put in reverse trend so that when prone the person is kind of slumped over that hump in the middle. It's hard to explain but if you try it with a coworker and play around with the bed settings you can find a position that they can tell you feels halfway okay and keeps them from sliding down.

Plus lots of pillows and we ALWAYS have RT at the head when proning/supining. ALWAYS.

[XYRNMN]

We use Rotoprone as well. While it does greatly improve oxygenation, I can't say with any confidence that it actually increasesa patient's chance of survival. Honestly, in the last 5 years, I have only seen one patient survive ARDS with help from the Rotoprone. This has been the worst flu season I have ever seen, and we have been using the Rotoprones fairly regularly this season. They have been so popular throughout the city (of Memphis) that we have actually had to place our patients on waiting lists for get a bed. Just last week, we had a patient wait for a week before we received a Rotoprone to place her on.

Not suggesting you guys are doing it wrong, but research tends to show that if facility survival rates for proning are lower than average it is likely the pts are not being proned early enough in their course. Just a thought.

[sweetspirit]

Don't delay proning you patient just because you don't have a bed!!! There are several great articles out there about the impact of proning on a patient's survival rates. With that being said, don't wait till your patient is knocking on heavens door to start harassing the doc about proning!!! Keep at it...know you P/F ratios...advocate, advocate, ADVOCATE!!! and get ready to "Roc" them :)

[TXLvn07]

We usually use the RotoProne bed at well.

However, we have some instensivists who don't believe its beneficial, so we just take it upon ourself to prone patients when we there is a diagnosis of ARDS.

[calivianya, BSN, RN]

We don't have any RotoProne beds - they sure sound nice. It just takes a bunch of people to prone a patient for us.

[Bluebolt]

We don't prone ARDS patients at all in my ICU. Actually this is the first I've ever even heard of proning a patient who is in ARDS. We usually start a paralytic, rotate pt from one side to another (mostly for skin breakdown), heavy sedation, Vent with increased Insp time and Decreased Expr time (reversed I:E ratio), PEEP of 10 and PS of 30 or more, Fi02 of probably 100%. Interesting to hear of different practices in different parts of the US.