Rotoprone bed therapy

According to one of our RRTs, there is newer research suggesting we prone more. I haven't read it myself and don't have sources, just an interesting comment.

My biggest challenge (other than it's a colossal pain in the gluteus maximus) is balancing the needs of the lungs and the needs of the brain, as most of our use is for our multiple traumas when they develop ARDS. Prone them, their ICPs shoot up...put them back supine, their oxygenation suffers.

I don't know that I can give you a good number on outcomes, since most of these people go to an LTACH vs. get better and come off the vent. They're still really sick when they leave us, so we usually don't know how they do long-term.

While I am a new RN, I am precepting in the ICU and my preceptor is the "super user" for our hospital. She states that the most recent research does indeed support the use of Rotoprone beds in ARDS patient. She says that the critical element is getting the patient on the Rotoprone very early on, as the bed becomes less effective (tapering off to ineffective) as time goes on.

Absolutely. The use of a rotoprone bed is good for the patient. But yes, it is a MAJOR PI the A.

The AACN article by Culpepper and Goldhill, you should be able to search them and find a good study/evidence

Proning has been around for at least 20 years. Where the doctors did their residency will influence the attitudes toward using the Rotoprone or whatever system in your unit. The physicians must be comfortable with managing ARDS for any therapy to work.

Some attitudes stem from the labeling of therapies as last ditch or salvage. This article is on the ATS website.

An Overview of Salvage Therapies for Acute Respiratory Distress Syndrome Caused By H1N1 Infection

While the information is good the name can lead some to believe this is a last ditch effort. We prefer to say "more innovative strategy". We also see changing positions can provide for better skin care. Nothing like skin breakdown to make recovery even more challenging.

But proning is not the only alternative therapy to be a late method when it should be initiated earlier by physicians or at least suggested by RTs. HFOV_ has been around for almost 30 years and some still fear it. Even the ARDSnet protocol is misundetstood and poorly instituted by some. APRV/Bilevel has been around for at least 15 years and some still do not understand it. It is sad to see a $40,000 ventilator used as if it was still an MA1. Some still have a difficult time understanding BiPAP and under utilize it or fail miserably when using it by a way too conservative approach.

But, some instead of utilizing what is readily available early, they start moving toward ECMO which transfer management of the patient. This is a good alternative but shouldn't always be the first direction to head.

They are nice once set up, but they are also expensive to rent....therefore my hospital manually prones patients. If they are a normal BMI it takes 4 nurses and we can do it in less than 10 minutes. We can flip them for CPR in less 1 if need be. But we may hurt afterwards.

tattooedrn,

The therapy is has been around for a while, but still considered "rescue therapy" or a last resort. However, there was a great article that was published in The New England Journey of Medicine that showed that there was a "In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality" which is more than those not treated with the therapy are likely to have. I have had several patient on the rotoprone bed and more are miracle cases for sure. But not many hospital or better yet many doctors that are familiar or comfortable with the therapy recommend it. Our hospital is planning a system wide study so some protocols and measure are being put in place for a large study. Hope this help

Reference

Guérin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., ... & Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159-2168.