ARDS - Proning

:rotfl: :rotfl:

ok.........I havent a clue what you are talking about!!! sounds like a different language!!!! I have definately been in primary care too long!!!

Karen

:rotfl: :rotfl:

ok.........I havent a clue what you are talking about!!! sounds like a different language!!!! I have definately been in primary care too long!!!

Karen

:chuckle Karen, I haven't been in primary care that long ...... and I also haven't got a clue what he is talking about

"Proning" = placing a patient in the prone position? Not any more in Psych! not a clue, sorry.

For those who do not care for this patient population, proning is an alveolus recruitment strategy for patients with acute lung injuries. These lung injuries resist ventilation stragegies alone because they, by definition, are ventilation/perfusion mismatch conditions. It is my experience, and that of the researchers, that prone positioning is not better than supine positioning, because it is aggressive lateral turning...60 degree turns, with at least 10 minute pauses on each side, that recruits alveoli. (To achieve this, I have used the RotoRest bed, the same hard platform, rotational bed used for years for patients with cervical spine disruptions.) In addition to aggressive lateral turning, we use high frequency oscillation ventilation, nitric oxide, and Xigris. My patients with ARDS almost always have this secondarily to septic syndrome. I hear that there is a bed in trials that will laterally turn 60 degrees and prone as well.

A friend of mine did her Master's thesis on prone positioning for ARDS in the pediatric patient three years ago. We've used it very effectively in some of our sicker patients and have seen positive outcomes in many cases, with no real negatives. I'll have a look and see if I can find my copy of the policy/procedure that came out of her research. I know it has to be in my house somewhere.

Aside to the onlookers:coollook:: prone positioning for Acute Respiratory Distress Syndrome is an increasingly accepted treatment modality. The theory behind it is that prone positioning supports the diaphragm and improves ventilation by recruiting underinflated alveoli on the dorsal (and usually dependent) surface of the lung. There's a lot more to it than just flipping the patient on their belly, though. They have to be properly supported so that their abdomens are off the bed in order to allow full excursion of the chest wall.

Janfrn: I had not seen your post when I replied with a repeat definition of proning...as you can see, we in adult critical care steal all the good ideas from peds LOL. But proning has been less successful in adults and it seems to be the absence of the lateral turning portion of treatment that makes the difference.