PROVIDER EXPERIENCE WITH PRONE POSITIONING FOR ARDS DURING COVID-19

The authors present a technical note for a prone positioning system developed to facilitate cervical extension osteotomy for ankylosing spondylitis in the presence of severe deformity and frailty. Chin-on-chest deformity represents one of the most debilitating changes of ankylosing spondylitis. Where the chin-brow angle approaches or exceeds 90°, prone positioning becomes problematic due to the fixed position of the head. Furthermore, the challenge is compounded where physiological deconditioning leads to frailty, and the side effects of medical therapies decrease muscle mass and skin quality. Conventional prone positioning equipment is not able to cater to all patients. A versatile system was developed using a 3D reconstruction to enable a positioning simulation and verification tool. The tool was used to comprehensively plan the perioperative episode, including spatial orientation and associated equipment. Three-dimensional printing was used to manufacture a bespoke positioning device that precisely matched the contours of the patient, reducing contact pressure and risk of skin injury. The authors were able to safely facilitate surgery for a patient whose deformity and frailty may otherwise have precluded this possibility. The system has potential safety and economic implications that may be of significant utility to other institutions engaging in complex spinal surgery.

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Faculty Opinions recommendation of Effect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158771.620001 ◽

2009 ◽

Author(s):

Marc Jeschke

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Meta Analysis ◽

Prone Positioning

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Faculty Opinions recommendation of The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13409129.14780156 ◽

2011 ◽

Author(s):

John Laffey ◽

Mairead Hayes

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Meta Analysis ◽

Prone Positioning

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Faculty Opinions recommendation of Positive end-expiratory pressure, prone positioning, and activated protein C: a critical review of meta-analyses.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7823959.8163057 ◽

2011 ◽

Author(s):

Jesús Villar

Keyword(s):

Critical Review ◽

Protein C ◽

Activated Protein C ◽

Prone Positioning ◽

Positive End Expiratory Pressure ◽

Meta Analyses

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Evaluation of PEEP and Prone Positioning in COVID-19 ARDS

SSRN Electronic Journal ◽

10.2139/ssrn.3622409 ◽

2020 ◽

Author(s):

Mirja Mittermaier ◽

Philipp Pickerodt ◽

Florian Kurth ◽

Laure Bosquillon de Jarcy ◽

Leif Erik Sander ◽

...

Keyword(s):

Prone Positioning

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Fifteen years of MAP implementation in Minnesota: Tailoring training to evolving provider experience and expertise

Journal of Family Social Work ◽

10.1080/10522158.2019.1694341 ◽

2020 ◽

Vol 23 (2) ◽

pp. 91-113

Author(s):

Charmaine K. Higa-McMillan ◽

Brad J. Nakamura ◽

Eric L. Daleiden ◽

Glenace E. Edwall ◽

Patricia Nygaard ◽

...

Keyword(s):

Provider Experience

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Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome

BMC Ophthalmology ◽

10.1186/s12886-021-02028-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirsty Michelle Clarke ◽

Vivi Riga ◽

Amy-lee Shirodkar ◽

Joel Meyer

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Visual Field ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Vision Loss ◽

Prone Positioning ◽

Disc Oedema ◽

Ischaemic Optic Neuropathy ◽

The Right

Abstract Background Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development. Case presentation : We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye. Conclusions NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.

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