Proning

MS. ICANDOIT · Dec 18, 2009

Sorry to be brief but wanted to share before I left for work....yes we've been proning for a couple of years with mixed results prior to the H1N1 influx. We've had lots H1N1 patients some we proned some we didn't and it didn't seem to help UNTIL...we added Nitric Oxide. Don't know why the docs had to argue amongst themselves and RT's for so long to get er done, but we are sending them out alive..... here's a link with a little info......

http://journals.lww.com/jtrauma/Abstract/2001/04000/Prone_Positioning_and_Inhaled_Nitric_Oxide_.1.aspx

sunnycalifRN · Dec 18, 2009

At my previous hospital, we used to prone ARDS patients occasionally. But, even with the special proning equipment that the patient was strapped in to, it required about 8 staff to prone the patient, anesthesia standing by, RT securing the airway. We accidentally extubated one patient. Bottom line, the ICU team decided the risk outweighed the benefit, so we stopped the practice.

MrBubbles · Dec 18, 2009

I have seen it have a positive result. Problem is, if you need to be proned, you are really sick, and usually the recognition that a pt needs to be proned comes too late. It's like stating that mortality is high in pts who get a SWAN, well yea, it's not the SWAN causing it, there's no correlation, it's just that they are sick. Proning is a last ditch effort, and yes, the rotoprone bed is Mutherf$%^&r to work with.

meandragonbrett · Dec 18, 2009

Yes we prone. The big problem is that it usually does not occur early enough.

nightshift82 · Dec 19, 2009

Thanks for the information. I guess there is really nothing about this that makes it easy. Would be good if we knew it was all worth while and perhaps you are correct in that it does not occur soon enough?

sunnycalifRN · Dec 20, 2009

Yes we prone. The big problem is that it usually does not occur early enough.

Yep. When I worked as an RT, I used to try get my early ARDS patients switched to PCV or APRV but the docs would hem and haw . . . "he's not that sick yet" . . . they'd wait until the ARDS was bonking them on the head before going to PCV or inhaled flolan (we don't have INO).

Fortunately, with the ARDSNET protocols, they are treating ARDS much earlier than they used to.

TemperStripe · Dec 20, 2009

We have had a few patients that they kind of talked about proning but never did...I've only heard it mentioned 2x in a year. Y Requires tons of effort on behalf of the staff and the pt as well.

CABGx4, ASN, BSN, MSN, CRNA · Dec 24, 2009

We prone many pt's especially in November with all the H1N1's we had 5 at one time. Using the rotoprone bed is a pain at first, but once you get the hang it's fine. As long as the pt can fit in the bed (we had one sort of slide out while being proned...I wasn't there so I'm not actually sure how this was able to happen, but the pt was huge and probably shouldn't have been on the bed in the first place.

Anyway, the docs here are getting better at recognizing the need for pronation earlier in the ARDS course, so pt's are having better outcomes. Of course, sepsis and oncology issues complicate matters. I have seen some a few people turn around after being prone for a week!!

Zookeeper3 · Dec 27, 2009

We have two pulmonologists, one prones in any and all circumstances, especially with Fio2>60%. His buddy comes in and covers next day and writes, do not turn patient (and yes he means from side to side, geeze).

So it's difficult to say, once we get increased recruitment, improved spo2 and can start weaning a touch, the other one changes course. so we're working it out, but many of our staff go through all the extra work because it does make a difference in our ICU stay.

Now long term morbidity mortality rates? Very many varriables for a brief discussion here, but I see the benefits outweigh the risks.

sunnycalifRN · Dec 27, 2009

We have two pulmonologists, one prones in any and all circumstances, especially with Fio2>60%. His buddy comes in and covers next day and writes, do not turn patient (and yes he means from side to side, geeze).

Let me guess, and these two hate each other, too? Wow, so extreme . . . what happened to "moderation"??

nightshift82 · Dec 27, 2009

Wow you must secretly be working at my hospital! The exact same thing happens here. The only good or bad is that they are on for a week at a time. We have 4, 2 of which are not like that but the other 2 have the same stupid behaviors. It is very frustrating for staff and families. Even if spoken with about these behaviors they are good for awhile but then revert back. Hmmm last time I checked it is supposed to be about the patient not beating on one's chest!