It is important to note that prone positioning refers to a technique that is utilized to improve breathing in patients with acute respiratory distress syndrome (ARDS). It is stated that “in prone positioning, patients lie on their abdomen in a monitored setting. Prone positioning is generally used for patients who require a ventilator (breathing machine)” (Hadaya and Benharash, 2020, p. 1361).
In other words, it is opposite to the supine positioning, which is the most common way of positioning since patients usually lie on their backs. Guérin et al. (2020, p. 2385) found that the “prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching.” The main reason is that the heart stops applying pressure on the lungs, which enables less compression of the lung tissue. In addition, the dependent lung regions undergo fewer cyclical closings and openings, whereas the non-dependent ones do not become excessively overdistended (Guérin et al., 2020). As a result, patient outcomes can be drastically improved by placing patients on their stomachs.
In terms of mortality, prone positioning has shown positive results. Evidence suggests that when patients are prone and positioned for 17 hours, they have from 15% (absolute) to 25% (relative) critical care mortality rate reduction (Dardeir et al., 2020, p. e10767). Therefore, the is a decrease in the mortality of ARDS patients when the measure is applied. In terms of morbidity, the illness becomes less severe due to lower levels of lung injury and enhanced oxygenation, which means that ARDS symptoms become more manageable (Gordon et al., 2019; Rampon, Simpson, and Agrawal, 2023). In addition, Weatherald et al. (2022, p. e071966) found that “awake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults.” Thus, both the state of illness and the rate of death are improved by prone positioning.
However, there is an important multidisciplinary element to the initiation and management of prone positioning. A physician should initiate prone positioning within the first 48 hours and not as a ‘rescue therapy’ for the measure to be effective (Dardeir et al., 2020). The duration of the prone positioning needs to be longer than at least 12 hours (Moran and Graham, 2021; Ghelichkhani and Esmaeili, 2020). As a result, a critical care nurse plays a central role in both the initiation and continuous management of prone-positioned patients. Since most physicians tend to use prone positioning as a rescue tool, nurses need to be aware of the critical condition indicators of patients. Informing physicians about the need for prone positioning early is important on the nurses’ front.
Nursing professionals’ roles include patient assessment and monitoring, managing potential complications, coordinating the repositioning process, and providing emotional support to patients and their families. The former refers to continuous observation and recording of vital signs, oxygen saturation levels, and the patient’s subjective experience (Ghelichkhani and Esmaeili, 2020). Regular checks of the endotracheal tube and ventilator circuits are necessary to prevent accidental dislodgement or obstruction.
Coordination of the repositioning process requires effective communication and teamwork skills. Turning a critically ill patient from supine to prone and the other way around is a complex procedure that involves multiple healthcare professionals (Dardeir et al., 2020). Being in a prone position can be uncomfortable and anxiety-inducing for patients. Nurses need to provide reassurance, explain the procedure and its benefits, and involve the patient in decision-making when possible. Therefore, the implementation and effectiveness of prone positioning are highly dependent on the skills, competence, and collaboration of the nursing team.
Reference List
Dardeir, A. et al. (2020) ‘Factors influencing prone positioning in treating acute respiratory distress syndrome and the effect on mortality rate’, Cureus, 12(10), p. e10767. Web.
Ghelichkhani, P. and Esmaeili, M. (2020) ‘Prone position in the management of COVID-19 Patients; a commentary’, Archives of Academic Emergency Medicine, 8(1), p. e48. Web.
Gordon, A. et al. (2019) ‘Prone positioning in ARDS’, Critical Care Nursing Quarterly, 42(4), pp. 371-375. Web.
Guérin, C. et al. (2020) ‘Prone position in ARDS patients: why, when, how and for whom’, Intensive Care Medicine, 46, pp. 2385-2396. Web.
Hadaya, J. and Benharash, P. (2020) ‘Prone positioning for acute respiratory distress syndrome (ARDS)’, JAMA, 324(13), p. 1361. Web.
Moran, J. L. and Graham, P. L. (2021) ‘Multivariate meta-analysis of the mortality effect of prone positioning in the acute respiratory distress syndrome’, Journal of Intensive Care Medicine, 36(11), pp. 1323-1330. Web.
Rampon, G. L., Simpson, S. Q. and Agrawal, R. (2023) ‘Prone positioning for acute hypoxemic respiratory failure and ARDS: a review’, CHEST, 163(2), pp. 332-340. Web.
Weatherald, J. et al. (2022) ‘Efficacy of awake prone positioning in patients with COVID-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials’, BMJ, 379, p. e071966. Web.