Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

Oliveira, Vanessa Martins de; Piekala, Daniele Martins; Deponti, Gracieli Nadalon; Batista, Danusa Cassiana Rigo; Minossi, Sílvia Daniela; Chisté, Marcele; Bairros, Patrícia Maurello Neves; Naue, Wagner da Silva; Welter, D.; Vieira, Sílvia Regina Rios

doi:10.5935/0103-507x.20170023

Cited by 50 publications

(73 citation statements)

References 22 publications

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“…1). (22) Some limitations of this study should be noted. First, this is a single center retrospective cohort study in a resource constrained environment under crisis operations.…”

Section: Discussionmentioning

confidence: 89%

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

Shelhamer

Wesson

Solari

et al. 2020

Preprint

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BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 (P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2:FiO2) were significantly improved during days 4-7 (P < 0.05 for all). CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

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“…1). (22) Some limitations of this study should be noted. First, this is a single center retrospective cohort study in a resource constrained environment under crisis operations.…”

Section: Discussionmentioning

confidence: 89%

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

Shelhamer

Wesson

Solari

et al. 2020

Preprint

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“…The existing literature on education about and implementation of PPV reflects the traditional nursingoriented approach to PPV. [18][19][20] In addition, many aspects of routine nursing care and quality metrics (eg, feeding) are directly affected by prone positioning. Our findings before training are consistent with previous studies that identified lack of perceived benefit and safety concerns as potential barriers to implementation of PPV.…”

Section: Discussionmentioning

confidence: 99%

“…17 The use of interprofessional simulation-based training before implementation of PPV has not been previously reported, with most studies focusing on training nurses. [18][19][20] Therefore, we sought to determine the impact of an interprofessional simulation-based training program on the perception of benefit and comfort with PPV among registered nurses, physicians, and respiratory therapists and to see whether such a program can help identify LSTs before implementation.…”

mentioning

confidence: 99%

Implementing Automated Prone Ventilation for Acute Respiratory Distress Syndrome via Simulation-Based Training

Poor

Acquah

Wells³

et al. 2020

American Journal of Critical Care

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Background Prone position ventilation (PPV) is recommended for patients with severe acute respiratory distress syndrome, but it remains underused. Interprofessional simulation-based training for PPV has not been described. Objectives To evaluate the impact of a novel interprofessional simulation-based training program on providers’ perception of and comfort with PPV and the program’s ability to help identify unrecognized safety issues (“latent safety threats”) before implementation. Methods A prospective observational quality improvement study was done in the medical intensive care unit of an academic medical center. Registered nurses, physicians, and respiratory therapists were trained via a didactic session, simulations, and structured debriefings during which latent safety threats were identified. Participants completed anonymous surveys before and after training. Results A total of 73 providers (37 nurses, 18 physicians, 18 respiratory therapists) underwent training and completed surveys. Before training, only 39% of nurses agreed that PPV would be beneficial to patients with severe acute respiratory distress syndrome, compared with 96% of physicians and 70% of respiratory therapists (P < .001). Less than half of both nurses and physicians felt comfortable taking care of prone patients. After training, perceived benefit increased among all providers. Comfort taking care of proned patients and managing cardiac arrest increased significantly among nurses and physicians. Twenty novel latent safety threats were identified. Conclusion Interprofessional simulation-based training may improve providers’ perception of and comfort with PPV and can help identify latent safety threats before implementation.

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“…Essa ventilação baseia-se em sua eficácia conhecida em pacientes com SDRA, 21 bem como em observações limitadas de pacientes com SDRA relacionadas ao COVID-19 que respondem bem a essa manobra. 22 A boa resposta à ventilação prona nesses pacientes deve-se ao fato de que esta posição resulta em distribuição mais uniforme do estresse e da tensão pulmonar, melhora da relação ventilação/perfusão, da mecânica pulmonar e da parede torácica.…”

Section: Ventilação Mecânicaunclassified

Manuseio do Paciente com COVID-19 em Unidade de Terapia Intensiva

Filho¹,

Maciel²,

Trindade³

et al. 2020

RCHSI

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A pandemia da COVID-19 trouxe um grande desafio para a equipe de unidade de terapia intensiva. Inicialmente pela grande quantidade de afluxo de pacientes, a falta de suprimentos gerou quadros mais severos de síndromes respiratórias agudas (SARS e outras) e mais longos nas unidades, em seguida os protocolos de não se por em risco a equipe laborativa e a falta de profissional qualificado para determinadas condições geradas pela doença, como a lesão renal aguda (LRA), criou um cenário estressante e desafiador para equipes médicas, para o doente e a família. Além disso, a falta de um conhecimento prévio sobre a doença colocou os médicos em posição de decisões para as quais ainda não havia literatura consubstanciada. Neste artigo tratamos desses desafios e das condutas relacionadas à necessidades geradas pela COVID-19 em UTIs principalmente no que concerne à ventilação mecânica.

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Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

Cited by 50 publications

References 22 publications

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

Implementing Automated Prone Ventilation for Acute Respiratory Distress Syndrome via Simulation-Based Training

Manuseio do Paciente com COVID-19 em Unidade de Terapia Intensiva

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