Efficacy and safety of prone positioning for patients with acute respiratory distress syndrome

Abstract

This article presents an overview of a literature review on how prone positioning can alleviate pathophysiological changes in ARDS and improve ventilation and perfusion. Improvement of gas exchange, efficiency of oxygenation and lung function are emphasized. Literature on the pathophysiology of ARDS, and the physiological effects of prone positioning on haemodynamics and lung function is examined. There are both advantages and disadvantages in turning a patient from the supine to the prone position. There are also contraindications in rotating between the supine and prone positions. Nevertheless, by rotating patients with ARDS, it is possible to achieve a significant improvement in A-aDO2, decrease shunting, and therefore improve oxygenation without use of expensive, invasive and experimental procedures. Placing patients with ARDS in the prone position can reduce inspiratory oxygen concentrations and peak inspiratory pressures, which minimizes the chance for barotrauma and the iatrogenic effects of hyperventilation oxygen toxicity.

Evaluation of oxygen saturation values in different body positions in healthy individuals

“…Studies conducted with individuals with pulmonary disease have shown, as in this study, oxygenation is better in a prone position (Breiburg et al . , Meade , Lin et al . , Das et al .…”

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

“…The following complications were described while in the prone positions [ 28 , 30 , 42 , 43 , 65 , 105 , 124 , 144 , 218 , 272 , 301 ] facial oedema (20–30 %), pressure ulcers around the face/cornea, pelvis, knee (approximately 20 %) [ 234 ] ‘intolerance’ while in the prone position (= coughing, compaction, respiratory problems approximately 20 %), cardiac dysrhythmias (approximately 5 %), necrosis of the mamilla, pressure ulcers of the tibial crest (individual reports), dislocations of the tracheal tube or venous/arterial lines (approximately 1–2 %) [ 105 ], nerve damage (two case studies regarding brachial plexus lesion [ 119 ]) (evidence level 2b). In this regard, it is necessary to consider that complications also occur in the supine position and a comparison of the incidences of position-related complications for the prone position has not previously been sufficiently studied.…”

“…Each positioning process—depending on the body weight of the patient as well as the invasiveness of the therapy (drainages, catheters, extensions)—is conducted by three to five nurses and one physician [ 13 , 17 , 18 , 42 , 138 , 190 , 195 , 207 , 254 , 260 , 276 , 303 , 304 ].…”

Prone positioning in the patient who has acute respiratory distress syndrome: the art and science

“…There was no change in CI or wedge pressure, leading to the conclusion that this reduction may be related to a lower pulmonary vascular resistance. Increases and decreases in CI are seen in a few studies [49,61,70,71]. These variations may reflect use of different techniques in measuring CI versus an actual change in physiology [72].…”