Bauchlagerung bei Beatmung – Schritt für Schritt

2019 ◽  
Vol 144 (14) ◽  
pp. 978-981 ◽  
Author(s):  
Tobias Bertram Vogt ◽  
Barbara Sensen ◽  
Stefan Kluge
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Standard Of Care ◽  
Prone Positioning ◽  
Severe Condition ◽  
Improve Outcome ◽  
Intensive Care Patients

AbstractThe Acute Respiratory Distress Syndrome is still a very severe condition in intensive care patients. Prone positioning is known to improve outcome in patients with moderate to severe ARDS. Therefore proning in these patients is nowadays to be regarded as a standard of care. The risks of proning are reasonably low – if proning is done correctly. Therefore a method of proning in a step-by-step-approach is shown in this article.

Nursing Management of Prone Positioning in Patients With COVID-19

2020 ◽  
pp. e1-e9
Author(s):  
Filippo Binda ◽  
Federica Marelli ◽  
Alessandro Galazzi ◽  
Riccardo Pascuzzo ◽  
Ileana Adamini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Older Patients ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Prone Positioning ◽  
Improvement Project

Background At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. Objectives To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. Methods A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. Results Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients. Conclusions Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

Prone Positioning of Patients With Acute Respiratory Distress Syndrome

2015 ◽  
Vol 35 (6) ◽  
pp. 29-37 ◽  
Author(s):  
Dawn M. Drahnak ◽  
Nicole Custer
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pulmonary Ventilation ◽  
Ventilatory Support ◽  
Positive Outcomes ◽  
Prone Positioning ◽  
Intensive Care Nurses

Effectively treating critically ill patients with acute respiratory distress syndrome (ARDS) is a challenge for many intensive care nurses. Multiple disease processes and injuries contribute to the complexity of ARDS and often complicate therapy. As a means of supportive care for ARDS, practitioners resort to rescue therapies to improve oxygenation and salvage the patient. The pathophysiology of ARDS and the use of prone positioning to improve pulmonary ventilation and oxygenation in ARDS patients are described. Educating nursing and medical staff on the use of prone positioning allows ease of patient placement with an emphasis on safety of both patients and staff. Scrupulous assessment of patients coupled with judicious timing of prone positioning expedites weaning from ventilatory support and contributes to positive outcomes for patients.

scholarly journals Correction to: Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in intensive care patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinle Lin ◽  
Wuyuan Tao ◽  
Jian Wei ◽  
Jian Wu ◽  
Wenwu Zhang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Renal Dysfunction ◽  
Prognostic Value ◽  
Distress Syndrome ◽  
Intensive Care Patients ◽  
Diagnostic And Prognostic Value

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3176
Author(s):  
Pin-Kuei Fu ◽  
Chen-Yu Wang ◽  
Wei-Ning Wang ◽  
Chiann-Yi Hsu ◽  
Shih-Pin Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Nutritional Risk ◽  
Prone Positioning ◽  
Icu Mortality ◽  
Achievement Rate

Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07–0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.

scholarly journals Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19: A Rehabilitation-Based Prone Team

2020 ◽  
Vol 100 (10) ◽  
pp. 1737-1745 ◽  
Author(s):  
Jillian A Ng ◽  
Lauren A Miccile ◽  
Christine Iracheta ◽  
Carolyn Berndt ◽  
Meredith Detwiller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Successful Implementation ◽  
Prone Positioning ◽  
Position Change ◽  
Number Of Patients

Abstract Objective Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive care unit staff at Brigham and Women’s Hospital. Methods A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety. Results The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. The volume of requests to the rehabilitation-based prone team generally increased to week 4 and has, since then, declined. Key points for successful implementation included identification of rehabilitation therapists with intensive care unit experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process. Conclusion The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation. Impact This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to coronavirus disease 2019 and will help guide other institutions.

scholarly journals Infection related catheter complications in patients undergoing prone positioning for acute respiratory distress syndrome: an exposed/unexposed study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guillaume Louis ◽  
Thibaut Belveyre ◽  
Audrey Jacquot ◽  
Hélène Hochard ◽  
Nejla Aissa ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Standard Of Care ◽  
Infectious Complications ◽  
Exposed Group ◽  
Control Group ◽  
Prone Positioning ◽  
Catheter Complications

Abstract Background Prone positioning (PP) is a standard of care for patients with moderate–severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. Method All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. Results A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1–Q3] PP session number was 2 [1–4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). Conclusion Our data suggest that PP is associated with a higher risk of CVC infectious complications.

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