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).

scholarly journals Does Prone Positioning Decrease Mortality Rate in ARDS? A Systematic Review

2018 ◽  
Author(s):  
Joseph Sarkis
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Supportive Care ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Prone Positioning ◽  
Reduce Mortality Rate

Acute Respiratory Distress Syndrome (ARDS) is a clinical condition in which the lungs suffer severe irreversible, large-scale damage causing a grievous form of hypoxemic respiratory failure. Acute respiratory distress syndrome is one of the most evasive diagnosis confronted in the Intensive care unit (ICU) as the name, definition and diagnostic standards have adapted over the past four decades. An ARDS diagnosis is established by physiological criteria and continues to be a diagnosis of exclusion, which makes it crucial that medical professionals expand their knowledge base to effectively diagnose ARDS. Patients admitted with ARDS have high mortality rates ranging from 40 to 60 percent. High-level quality supportive care continues to be the sole option for ARDS treatment. Even with improved supportive care, however, ARDS prognosis is still poor. Extended prone positioning (PP) has been shown to increase alveolar recruitment end expiratory lung volume, thereby improving oxygenation and survival. Unfortunately, few studies have examined the association of mortality and prone positioning in ARDS. A systematic review was conducted to examine the following research question: Does prone positioning compared to supine positioning in patients with ARDS decrease mortality rates? This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP). A literature review was performed and data were collected from each study. A cross study analysis was performed and PP was found to reduce mortality rate in patients who were severely hypoxic. The reviewed studies demonstrated that incorporating early and longer periods of PP may improve mortality in ARDS patients, but further research is needed.

An Evidence-Based Protocol for Manual Prone Positioning of Patients With ARDS

2021 ◽  
Vol 41 (6) ◽  
pp. 55-60
Author(s):  
Patrick Ryan ◽  
Cynthia Fine ◽  
Christine DeForge
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Unplanned Extubations

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.

Prone Positioning has no Effect on Mortality in ARDS

2008 ◽  
Vol 9 (3) ◽  
pp. 264-265
Author(s):  
Alex Puxty ◽  
Chris Cairns ◽  
Malcolm Daniel
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Simplified Acute Physiology Score ◽  
Prone Positioning ◽  
Level Of Evidence ◽  
Subsequent Change ◽  
Saps Ii ◽  
Change In Practice

In patients with acute respiratory distress syndrome (ARDS), prone positioning improves oxygenation but has no impact on mortality, except perhaps in those with Simplified Acute Physiology Score (SAPS) II >50. Level of evidence: 1+ (SR based on small RCTs, conducted prior to ARDSNet – subsequent change in practice)

Gas Exchange of prone positioning in influenza pneumonia-related acute respiratory distress syndrome: A multicenter retrospective cohort study in Taiwan

2019 ◽  
Author(s):  
Ko-Wei Chang ◽  
Shih-Wei Lin ◽  
Li-Pang Chuang ◽  
Shinn-Jye Liang ◽  
Kuang-Yao Yang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Prone Positioning ◽  
Younger Age ◽  
Influenza Pneumonia ◽  
Paco2 Level

Abstract Background: Prone positioning has demonstrated decreased mortality in severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the effect of prone positioning in patients with influenza pneumonia-related severe ARDS. Methods: This retrospective study includes eight tertiary referral centers. All the patients with influenza pneumonia induced severe ARDS and receiving prone positioning were enrolled. Demographic data, laboratory data, treatment record, ventilator setting data and outcomes were collected. PaO2 responders were defined as the PaO2/FiO2 ratio increasing by ≥20% or ≥20 mm Hg, while PaCO2 responders were defined as PaCO2 decreasing by ≥1 mm Hg after prone positioning for one day. Results: Sixty-five patients receiving prone positioning were enrolled, with 37 (57%) were PaO2 responders and 33 (51%) were PaCO2 responders. Mortality rates were not significantly different between responders and non-responders. PaCO2 responder survivors had significantly shortened length of stay at the ICU (21.0 ± 13.5 vs. 31.7 ± 18.5 days, P = 0.038) and hospital (30.2 ± 16.6 vs. 43.0 ± 16.3 days, P = 0.013) than did non-responders. Multivariate analysis revealed younger age (odds ratio 0.903, 95% confidence interval 0.824-0.989; P = 0.028) and higher PaCO2 level before prone positioning (odds ratio 1.121 confidence interval 1.020-1.231; P = 0.017) were the predictors of PaCO2 responders. Conclusions: In this multicenter retrospective cohort study of influenza pneumonia patients with severe ARDS receiving prone positioning, PaCO2 responders had modestly better clinical outcomes. Younger age and higher PaCO2 level before prone positioning were the predictors of PaCO2 responders. Keywords: Prone positioning, Acute Respiratory Distress Syndrome, Influenza, Gas exchange, Outcome

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