Clinical Use

• The Primary Indication is for Severe ARDS with Refractor Hypoxemia
  • *See Acute Respiratory Distress Syndrome (ARDS)
• Can Improve Gas Exchange and Oxygenation
• No Significant Change in Minute Ventilation or CO2 Clearance
• *Early Enteral Nutrition While Prone is Safe and Recommended

Contraindications

• Spinal Instability
• Unstable Fractures
• Open Chest or Unstable Chest Wall
• Open Abdomen
• Elevated Intracranial Pressure (ICP)
• Extreme Obesity
• Acute Bleeding
• Hemodynamic Instability
• Untrained Staff

Physiologic Benefits

• Beneficial Effects are Due to Changes Gravitational Force
• Decreases Lung Compression from the Heart and Abdominal Organs, Reducing Areas of Collapse
  • Increased Functional Residual Capacity (FRC)
• Redistributes Air Flow and Blood Flow More Evenly to Improve Gas Exchange
  • Optimizes V/Q Matching
  • Reduces the Pleural Pressure Gradient from Nondependent to Dependent Regions
• Less Ventilatory Support Decreases Risk for Ventilator-Induced Lung Injury
• Increased Blood Return to the Right Heart to Improve Heart Function
• Improved Secretion Clearance from Mouth/Nose Facing Down

Technique

• Positioning Requires a Team of Trained Professionals
  • Risk for Dislodgement of Endotracheal Tubes or Other Medical Devices If Not Done Properly
• Appropriately Pad Any Areas of Pressure (Face, Chest, Pelvis, Knees)
• Daily Duration Varies (Commonly Done for 12-16 Hours Prone, 8 Hours Supine, Then Repeat)
• Automated Beds are Commercially Available to Facilitate the Process (RotoProne ^®, Provona=O2 ^®)

Complications

• Endotracheal Tube Obstruction or Dislodgement
• Dislodgement of Other Medical Devices (Chest Tubes, Lines, etc.)
• Procedures (Reintubation, Chest Tube Placement, Central Line Placement, and CPR) are Significantly More Difficult in the Prone Position
• Pressure Injury (Face, Eyes, Chest, Pelvis, Male Genitalia, Knees)
• Facial Edema
• Increased Intracranial Pressure (ICP)
• Increased Intraabdominal Pressure