Effect of Prone Positioning on Intraocular Pressure in Patients With Acute Respiratory Distress Syndrome

Abstract

Objectives: To evaluate the effect of prolonged duration of prone position (with head laterally rotated) on intraocular pressure in acute respiratory distress syndrome patients. Design: Prospective observational study. Setting: University hospital ICU. Patients: Twenty-five acute respiratory distress syndrome patients, age 60 years (51–67 yr), Sequential Organ Failure Assessment score 10 (10–12), Pao 2/Fio 2 ratio of 90 (65–120), and all in septic shock. Interventions: None. Measurements and Main Results: Intraocular pressure (in mm Hg) measured by hand-held applanation tonometer, at different time points. Before prone (in both eyes): at 30–45° head-end elevation position (THE pre-prone), in supine position just before turning prone (Tsupine pre-prone); during prone (in nondependent eye): at 10 minutes (T10 prone), 30 minutes (T30 prone), and at just before end of prone session (Tend-prone). After end of prone session (both eyes): at 5 minutes (T5 supine post-prone), 10 minutes (T10 HE post-prone), 15 minutes (T15 HE post-prone), and 30 minutes (T30 HE post-prone). Median duration of prone position was 14 hours (12–18 hr). Median intraocular pressure increased significantly (p ≤ 0.001) in both eyes. In dependent eye, from 15 (12–19) at THE pre-prone to 24, 21, 19, and 16 at T5 supine post-prone, T10 HE post-prone, T15 HE post-prone, and T30 HE post-prone respectively, whereas in nondependent eye from 14 (12–18.5) at THE pre-prone to 23, 25, 32, 25, 22, 20, and 17 at T10 prone, T30 prone, Tend-prone, T5 supine post-prone, T10 HE post-prone, T15 HE post-prone, and T30 HE post-prone respectively. Bland-Altman plot analysis showed significant linear relationship (r = 0.789; p ≤ 0.001) with good agreement between rise in mean intraocular pressure of the both eyes (dependent eye and nondependent eye) with their paired differences after the end of different duration of prone session (T5 supine post-prone). Conclusions: There is significant increase in intraocular pressure due to prone positioning among acute respiratory distress syndrome patients. Intraocular pressure increases as early as 10 minutes after proning, with increasing trend during prone position, which persisted even at 30 minutes after the end of post prone session although with decreasing trend.

Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review

“…Care Nurses (28) and the Associação de Medicina Intensiva Brasileira (29) Regarding complications, even though prone positioning was found to decrease pressure on bony prominences commonly injured in the supine or lateral positions (30) , PP exerts pressure on the frontalis and orbicularis muscles, chin, humerus, thorax, pelvis, and knees, causing several related adverse events (31) . generally self-limiting (32) .…”

Prone Positioning Covid-19 Patients: A Double-Edged Sword—A Case Report of a Devastating Ocular Complication

“…The prone position is associated with elevated intraocular pressure, and that increase correlates with the duration of the prone period, as demonstrated by Saran et al [ 11 ]. The exact mechanism underlying this elevation remains uncertain, but the gravitational effect leading to increased orbital venous pressure, the subsequent periorbital edema, and direct compression on the eye are reliable explanations.…”

Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic

“…Saran et al 58 recently investigated the effect of prolonged proning for a median duration of 14 hours in ventilated critically unwell patients with ARDS in a single center. They demonstrated a significant increase in median IOP from baseline (supine, 14 mmHg) to the prone position (23 mmHg, 10 minutes prone), which increased further during the proning period (32 mmHg, non-dependent eye, just before end of prone session), before trending back to baseline post-proning (17 mmHg, 30 minutes post-prone).…”