Increasing the Utilization of Prone Positioning During Mechanical Ventilation for Acute Respiratory Distress Syndrome: A Single Academic Medical Center Quality Improvement Intervention

Background Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device. Review of Evidence A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment. Implementation An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation. Evaluation This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications. Sustainability Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods. Conclusions Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.

Download Full-text

Implementation of a Low-Cost Quality Improvement Intervention Increases Adherence to Cancer Screening Guidelines and Reduces Healthcare Costs at a University Medical Center

Journal of Cancer Education ◽

10.1007/s13187-019-01544-z ◽

2019 ◽

Vol 35 (5) ◽

pp. 930-936

Author(s):

Alejandro Recio-Boiles ◽

Michael Karass ◽

Jose N. Galeas ◽

Vineeth Sukrithan ◽

Andrew H. Gutwein ◽

...

Keyword(s):

Quality Improvement ◽

Cancer Screening ◽

Healthcare Costs ◽

Medical Center ◽

Low Cost ◽

Quality Improvement Intervention ◽

Screening Guidelines ◽

Improvement Intervention

Download Full-text

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.

Download Full-text