Prone Positioning

christianRN · Aug 24, 2002

Yes, I have seen some articles, particularly in RN magazine about prone positioning. We don't really do this at our ICU. From the studies, it looks like it is very beneficial.

suetje · Aug 29, 2002

In our unit at the University of Michigan, we have a proning protocol. We routinly prone patients who have ARDS, and usually they are on an Fio2 of over 50%. The protocol states no more than 6 hours prone, but often that is quite long. One of the key reasons we chose 6 hours on and 6 off, was that we often prone ECMO patients and the risk of decannulation by flipping the pt. often is greater, obviously each time they are turned. We observe pt. tolerance and let that guide us more than anything. GREAT results, though!!!

taco · Sep 15, 2002

in our unit in a university hospital in holland we have also proning protocol. after turning on the prone we turned the patient for the first time on the back after 24 hours. the results are different.

TraumaNurse · Nov 11, 2002

I worked in one trauma center that used stryker beds and would prone ARDS patients 2-3 hours down and then 2-3 hours supine. They were very agressive about proning and actually had been actively involved in a couple of the proning studies. The other trauma center I worked in proned on occassion, usually 4-6 hours down and then supine for 6 hours.

When the patients really need it, proning is excellent at recruiting those extra aveoli....I'm a believer!

baseline · Nov 11, 2002

I'll PM you later tonite with some info I think I have at work......If you think its helpful I can fax it to you.

megmermaid · Dec 22, 2002

I don't see this often in our unit...it has a stigma. We probably wait too long because it seems like that is when they code. We don't have that many ARDS patients, though, they seem to end up more in MICU.

Good luck with your thesis.

Gardengal · Dec 22, 2002

We prone ARDS patients in our unit, but only with an MD order and i think it's usually too late to be very beneficial, although we have had several occasions when it was. We have a written procedure and a how to video.Many of the nurses are resistant to proning, although they admit it can be beneficial. there is always the potential for extubation, line dislodgement, etc. Our procedure states 4-6 hours for proning then to make supine again. We have had patients though who end up prone much longer because they desaturate so badly and oxygenation is so much worse when supine. We do reposition them a bit every couple of hours though to relieve presure areas.

suetje · Dec 23, 2002

When proning, you really have to start EARLY. It's like anything else...wait to long to treat and it will not work as well. We do a p/F ration to determine if they are a candidate (PO2 to / FiO2 ratio). You do the math, look at toehr things like what are thier vent settings now, what is their problem (open abdomen for example) and lines. If you are careful, you can do it. We do it a lot even with our ECMO pts. and their lines are VERY large.

ferselle · Jan 4, 2003

In our unit, we usually prone our patient with severe ARDS and with continuous prostacyclin nebulizations. FIO2 of more than 70%. We alternately prone patient every 12 hours and some patients benefitted, some are not. Our unit have no written protocol in proning patients.

burt · Apr 18, 2003

At our teaching hosp in Texas, we rarely prone patients. To my knowledge of 14 yrs, we have only done it 2 or 3 times. This was without a Stryker frame; it took about 6 people to turn the patient and watch the lines; you can imagine the horror; I don't even remember now how the patient did! I think it would probably be good for the patients, but we need to have a written protocol and get a lot more practice. We seem to be very slow to try new things here. I have never seen a patient on ECMO or have never heard of prostacyclin nebs! :idea: :idea:

mattsmom81 · Apr 18, 2003

I know what ya mean Burt...while I know the huge hospitals in DFW do these cutting edge types of things, my little ol' ICU doesn't go there much either.

One reason I enjoy my agency shifts is I get some exposure to the latest high tech stuff then. :)

Prone positioning is ordered by a few select pulmonologists only and we have seen mixed results. And yes..it's a nightmare as we have to do it 'manually' too.