Good practices for prone positioning at the bedside: Construction of a care protocol

Abstract

SUMMARY Last year, interest in prone positioning to treat acute respiratory distress syndrome (ARDS) resurfaced with the demonstration of a reduction in mortality by a large randomized clinical trial. Reports in the literature suggest that the incidence of adverse events is significantly reduced with a team trained and experienced in the process. The objective of this review is to revisit the current evidence in the literature, discuss and propose the construction of a protocol of care for these patients. A search was performed on the main electronic databases: Medline, Lilacs and Cochrane Library. Prone positioning is increasingly used in daily practice, with properly trained staff and a well established care protocol are essencial.

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

“…Alternatively, thoracic echography can be performed to evaluate the pulmonary parenchyma and catheter position. (20) …”

“…Two technicians should position themselves on either side of the patient, next to the legs. (20) In the case of an obese patient, two more people can be added to the team. A team member who is not involved in the maneuver should perform the checklist.…”

“…The tasks are divided into nutritional care (suspend feeding and open the nasoenteric tube 2 hours before the procedure); material care (provide cushions; place the crash cart and intubation unit close by; test aspiration equipment and bag-valve-mask device [AMBU]); general care (provide eye and skin care, review the fixation of invasive and curative devices, suspend continuous hemodialysis [recirculate and heparinize catheter]); airway care (airway aspiration; check fixation of the cord; record mouth corners and cuff pressure of the endotracheal tube; pre-oxygenate the patient with inspired oxygen fraction - FiO 2 : 100% for 10 minutes); and analgesia and sedation care (assess the need for increased sedation and curarization [evaluate the bispectral (BIS) index value, when available]). (5,20) …”

“…Next, the performance procedures are read aloud (place head in a flat position and align limbs, position the pelvis and chest cushions, and suspend and disconnect infusions), and the envelope is formed (Figures 3 to 5). (4,5,20) …”

“…The instrument was based on a care protocol (20) that was constructed on the basis of a broad review of the literature identified with a thorough search of the main electronic databases (MEDLINE, Latin American and Caribbean Health Sciences Literature [Literatura Latino-Americana e do Caribe em Ciências da Saúde - LILACS] and COCHRANE) for the period between January 1995 and March 2016. Original studies or reviews were included, without language restrictions.…”