scholarly journals Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning—A Clinical Commentary

2020 ◽  
Vol 35 (12) ◽  
pp. 1576-1582
Author(s):  
Ashley I. Simpson ◽  
Kalpesh R. Vaghela ◽  
Hazel Brown ◽  
Kate Adams ◽  
Marco Sinisi ◽  
...  
Keyword(s):  
Critical Care ◽  
Brachial Plexus ◽  
Distress Syndrome ◽  
Brachial Plexus Injury ◽  
Injury Rate ◽  
Prone Positioning ◽  
Care Guidelines ◽  
Conscious Patient ◽  
Key Steps ◽  
Ventilated Patients

Introduction: Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients. Methods: A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times. Discussion: There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified. Conclusion: There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.

scholarly journals Prone position plexopathy: an avoidable complication of prone positioning for COVID-19 pneumonitis?

2022 ◽  
Vol 15 (1) ◽  
pp. e243798
Author(s):  
Josh King-Robson ◽  
Eleanor Bates ◽  
Elisaveta Sokolov ◽  
Robert D M Hadden
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Brachial Plexus ◽  
Prone Position ◽  
Distress Syndrome ◽  
Brachial Plexus Injury ◽  
Brachial Plexopathy ◽  
Prone Positioning ◽  
Life Saving ◽  
Avoidable Complication

Prone positioning is a mainstay of management for those presenting to the intensive care unit with moderate-to-severe acute respiratory distress syndrome due to COVID-19. While this is a necessary and life-saving intervention in selected patients, careful positioning and meticulous care are required to prevent compression and traction of the brachial plexus, and resultant brachial plexopathy. We describe two patients who developed a brachial plexus injury while undergoing prone positioning for management of COVID-19 pneumonitis. Both patients were diabetic and underwent prolonged periods in the prone position during which the plexopathy affected arm was abducted for 19 and 55 hours, respectively. We discuss strategies to reduce the risk of this rare but potentially disabling complication of prone positioning.

scholarly journals Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

2020 ◽  
Author(s):  
Mehdi Shelhamer ◽  
Paul D. Wesson ◽  
Ian L. Solari ◽  
Deanna L. Jensen ◽  
William Alex Steele ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Competing Risks ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Hospital Death ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Physiologic Parameters ◽  
Ventilated Patients

Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 (P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2:FiO2) were significantly improved during days 4-7 (P < 0.05 for all). CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

scholarly journals Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19: A Cohort Study and Analysis of Physiology

2020 ◽  
Vol 36 (2) ◽  
pp. 241-252
Author(s):  
Mehdi C. Shelhamer ◽  
Paul D. Wesson ◽  
Ian L. Solari ◽  
Deanna L. Jensen ◽  
William Alex Steele ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Competing Risks ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Hospital Death ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Physiologic Parameters ◽  
Ventilated Patients

Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19. Methods: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning. Results: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 ( P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2: FiO2) were significantly improved during days 4-7 (P < 0.05 for all). Conclusions: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every 8 patients treated. Replicating results and scaling the intervention are important, but prone positioning may represent an additional therapeutic option in patients with ARDS due to COVID-19.

scholarly journals Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19

2021 ◽  
Vol 10 (13) ◽  
pp. 2969
Author(s):  
Elizabeth M. Parker ◽  
Edward A. Bittner ◽  
Lorenzo Berra ◽  
Richard M. Pino
Keyword(s):  
Distress Syndrome ◽  
Tissue Injury ◽  
Blood Gases ◽  
Tracheal Extubation ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Single Turn ◽  
Baseline Values ◽  
Ventilator Settings ◽  
Ventilated Patients

Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150.

Prone positioning in patients with acute respiratory distress syndrome: the Vollman Prone Positioner

1999 ◽  
Vol 19 (4) ◽  
pp. 66-71 ◽  
Author(s):  
DG Klein
Keyword(s):  
Critical Care ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Mortality ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Prone Positioning ◽  
Inexpensive Method

ARDS continues to be associated with high mortality rates despite numerous advances in critical care. Improvements in oxygenation can be achieved by placing patients with ARDS prone. The Vollman Prone Positioner offers an easy, safe, and inexpensive method to turn patients prone (for more information: www.vollman.com).

Sign in / Sign up

Export Citation Format

Share Document