Prone Positioning of the Burn Patient With Acute Respiratory Distress Syndrome

Abstract

Acute respiratory distress syndrome (ARDS) is a common sequela of severe burns and inhalation injury. The massive inflammatory reaction that follows deep burn injury, compounded by episodes of sepsis and organ dysfunction, predisposes patients to the development of ARDS. Prone positioning as a means of improving gas exchange has shown benefit in refractory cases of ARDS, but it is not well described in the burn population. We present a case report of a patient with severe ARDS who underwent prone positioning, review the relevant literature, and provide a discussion of practical concerns.

Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS

“…In our study, the majority of ARDS were caused by infectious disease. And we totally agree that PP combined with HFNC should be tried in noninfectious ARDS patients, which was reported in previous studies and case series [7][8][9]. However, as reported by Perez-Nieto et al, the use of prone positioning of the patients with complex chest traumas and post status of thoracic surgery is sparse and relatively controversial [8].…”

An Introduction to Burn Care: The Sequel

“…The development of acute respiratory distress syndrome (ARDS) is a major threat, and a prone position improves gas exchange in the lungs. 25 Patients with ARDS require immediate intubation, but its severity in burn care is not always recognized by "nonburn" (ie, emergency care) personnel. Diagnostic bronchoscopy cannot always be (rapidly) performed, and results are often subjective.…”

Acute Respiratory Distress Syndrome, Mechanical Ventilation, and Inhalation Injury in Burn Patients

“… 58 Data on PP of burn patients are limited; it presents logistical and safety challenges. 59 A case series reports improvements in oxygenation and a low rate of complications in patients with burn-related ARDS undergoing PP. 60 PMV should continue to be used during PP, and reassessment of ventilatory parameters should be performed, as respiratory mechanics may change with proning.…”