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Prone Positioning for Acute Respiratory Distress Syndrome (ARDS)

Mar 23, 2024
Prone

positioning

has been used to improve oxygenation in patients with

acute

respiratory

distress

syndrome

or

prone

positioning

with SDR is generally considered used when the PF ratio (pao2 divided by fio2) is 150 or less, depending on the trial. pro seva published in In 2013, we developed a four-phase checklist to facilitate the process of placing the patient in the

prone

position, shown in this video. The phase one checklist involves incorporating the interdisciplinary team to prepare the patient to be placed in the prone position. The highlight of this checklist is to ensure that the invasive lines are placed on the same side as the patient.
prone positioning for acute respiratory distress syndrome ards
This is not a contraindication in case the lines are on opposite sides, but one-sided lines are the preferred method in case the invasive lines are on opposite sides. On both sides, the central line has priority over the arterial line. This will be explained later in the video. Patients should be sedated according to ventilator synchrony. If the patient is sedated until the negative 5 stops and continues to show desynchrony, a paralytic can be administered. Assessment of the skin from head to toe should be documented, and foam dressings should be placed on bony prominences. Neck mobility should be evaluated and a new endotracheal tube support with foam dressings placed under the cheek support to provide additional protection to the skin.
prone positioning for acute respiratory distress syndrome ards

More Interesting Facts About,

prone positioning for acute respiratory distress syndrome ards...

Phase 2 checklist the shift team will meet, consisting of five to six members, ideally the sixth person will be hands-off by reading the checklist steps out loud and monitoring vital signs the fifth person will be the

respiratory

therapist located at the head of the bed and two staff members will be present on each side of the patient. The respiratory therapist will pre-oxygenate the patient with 100% oxygen. It will ensure that there is enough clearance in the fan circuit. The head of the bed will be removed. Staff members will move the bed to the desired position. Inflate the bed to maximum, lay it flat and the side rails will be removed.
prone positioning for acute respiratory distress syndrome ards
The respiratory therapist will now discuss airway management to reduce the risk of involuntary extubation. The RESP rate displayed should maintain the airway with one hand holding the endotracheal tube along with the jaw with the other hand placed under the patient's occiput to support the neck in this way if the patient moves the hand moves with the head and endotracheal tube from here on all movements will be executed with the respiratory therapist's 3-step count 1 we will ensure that the lines and tubes from the waist up are placed tow

ards

the head of the bed and that the lines and the tubes from the waist down are positioned tow

ards

the foot of the bed.
prone positioning for acute respiratory distress syndrome ards
Make sure there is sufficient clearance between all lines, tubes, and monitoring equipment. This may involve moving the IV pole and monitor closer to the head of the patient's bed. Step 2. A maxi tube or slip sheet will be placed under the patient's current sheet. Make sure it is as far below the patient as possible. The next step is to remove the patient's gown. EKG cables and EKG electrodes we will make sure that the patient's arterial line transducer is attached to the side of the patient's chest where the invasive lines are located that way we can continue to monitor the pulse in the absence of telemetry now we will reach in more Close to the ventilator under the patient's buttock with the palm facing up, we will place a pad underneath over the patient's chest and pelvis, this will help to envelop moisture when the patient is in a prone position.
Standard pillows will be placed on top of the patient in a horizontal position one on the patient's chest one on the pelvis and one on the knees the one on the knees is especially important to help prevent pressure ulcers in the knees the idea behind the pillows is to ensure that the abdomen is unloaded, depending on the size of the patient, you may need to use more than one thoracic pelvis pillow, etc. If you want the top surface to be as flat as possible, a flat sheet will now be placed on top of the patient that will cover everything except the patient's head.
The bottom and top sheets will now be rolled tightly together covering the patient. At this time, the maxi tube will remain under the patient to help us with repositioning. At this time, the respiratory therapist will remove the patient's pillow and place their hands in the position described. previously, if requested by the respiratory therapist on the count of three, the patient will be elevated to the head of the bed now, on the artistic count of three, the patient will be moved horizontally as far as possible from the ventilator on the artistic count of three , the patient will be rotated 90 degrees to the lateral position for an artistic count of three, the patient will be slid horizontally away from the ventilator for an artistic count of three, the nurses in front of the ventilator will remove the rolled sheets from under the patient while the other nurses carefully position the patient in prone position.
We will now move on to Phase Three of patient care while the checklist is in the prone position. The bed will be placed in the reverse Trendelenburg position of 10 to 20 degrees if the patient needs a more centered position on the artistic count of three, the patient will be moved, now the maxi tube can be removed along with the flat sheet, the cables of the ECGs can be placed on the patient's back and a wedge will be placed under the patient's shins to elevate the toes off the surface of the bed at this time. We will also level and zero our invasive monitoring equipment.
We will use a fluidized positioner that will be placed under the patient's head so that the respiratory therapist will be assisted in elevating the patient's chest. The patient's ears will be checked to make sure they are not compressed. and foam dressings can be applied to prevent pressure injuries, assess the face for bony prominences and shape fluid Iser pillows so that pressure points are relieved and both eyes can be visible. Now the Foley stat block can be placed on the patient's thigh and that is how the patient is placed in the prone position and now we will go over the process of tilting the patient's head from side to side and placing the patient's arms in the position. of swimmer The patient's head and arms will be repositioned every four hours if the face is on.
On the right side, the opposite arm will be placed up while the other arm will be placed down and vice versa. This can be done in two different ways. The first way is to elevate the patient to the head of the bed so that the head floats. the mattress, then the RT can tilt the head to the opposite side. The second way is to pull the patient's chest up while the RT repositions the head to the opposite side. The arms will move into the swimmer's position as we described above. manual supination we will now teach you how to place the patient back into the supine position from the prone position first we will make sure that the lines and tubes that are from the waist up are placed towards the head of the bed and lie on tubes from waist down.
They are positioned towards the foot of the bed, we are going to make sure we have enough slack, we are going to inflate the bed to the maximum, lay it flat, we are going to remove the patient's gown, the ECG cables and the ECG electrodes, we are going to reach in of the patient who is on the opposite side of the ventilator under the patient's hip with the palm facing up, then we will place a maxi tube or sliding sheet under the patient's current sheet, at this time we fix it by making sure the transducer is taped to the side of the chest where If invasive lines are present, then we will place a pad under the patient's buttocks, place a sheet on top of everything covering the patient except the patient's head, and roll up the bottom and top sheets firmly together, covering the patient at this time.
At this time, the respiratory therapist will remove the patient's pillow and place his or her hands on the patient's neck and occiput as described in the steps above. If requested by the RT with the RTS count of three, the patient will be elevated to the head of the bed at which time the patient will be moved horizontally to the edge of the bed closest to the ventilator with the count of three. The patient will be rotated 90 degrees to the lateral position with the ET tube facing the ventilator for a count of three. three while the patient is in the lateral position, slide the patient horizontally toward the ventilator counting artistically to three nurses on the side of the ventilator will remove the rolled sheets from under the patient while the other nurses carefully turn the patient to the supine position in this maneuver.
It is performed according to the pro seva test. For 16 hours the patient remains in a prone position and for two to four hours the patient returns to a supine position. At this time we will evaluate the patient's arterial blood gases and if the PF index is still 150 or less we will go through more cycles of pronation and supination.

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