Short Term Evaluation of Prone Positioning in Patients with Acute Respiratory Distress Syndrome

Abstract

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute process results in moderate to severe loss of lung function. The extrapolated statistics estimated the burden of ARDS in Egypt in 2009 as about 42080 cases out of 7.6 million of the population, with mortality rates from 10-90%. The high mortality associated with ARDS means that the cost of treating these patients is substantial. Despite the increase in technological advances in this area over recent years, treatments have failed to improve the prognosis or to reduce mortality of patients with ARDS or ALI, hence, prone positioning may have a role as a rescue therapy for patients with severe refractory hypoxemia. Aims of the study: This study aimed to: Evaluate the short term effects of prone positioning on oxygenation and lung mechanics of patients with acute respiratory distress syndrome. Research design: A quasi experimental research designed has been utilized in this study. Research setting: The study was conducted at Intensive Care Unit, King Abdul-Aziz Air Base Hospital. Dhahran. Kingdome of Saudi Arabia. Subjects: Study subjects of 25 acute respiratory distress syndrome patients were enrolled in this study conveniently. They were divided into two groups, experimental (15 patients) and control groups (10 patients).

Tools of the study: 1. Patient data sheet: It is a patient assessment sheet designed to encompass four parts, concerning demographic characteristic of the studied subjects, mechanical ventilation parameters, patient baseline assessment, and patient follow up assessment data 2. Lung injury score: It was used to diagnose ALI/ARDS severity to assess the extent of acute pulmonary damage. 3. Clinical practice guidelines for prone positioning: It was developed to improve oxygenation through the use of prone position whilst promoting patient safety, and to standardize the use of prone position. Results: There was a statistical significant improvement between PaO2/FIO2 at (0 hour) on one hand, (1) hour, and (6) hours on oxygenation parameter (lung compliance). Regarding the hemodynamic stability, a non statistically significant difference was shown between blood pressure (systolic, and diastolic), heart rate, and CVP at (0), (1), and (6) hours at (P>0.05). Conclusion The short term evaluation of prone positioning in ARDS was valuable in term of better lung oxygenation with no hemodynamic compromise, no major complications, is safe for patients and convenient for both medical and nursing staff.

Recommendations: Nurses can be proactive in decisions to instigate treatments as prone positioning and it is the time for nurses to take a more active part in the utilization of this safe adjunct therapy, to intensify education and knowledge of ICU medical and nursing staff about the role of prone position in critically ARDS patients and to include prone turning in the standard units’ practice of turning (right, back, left, and prone), and to adapt and adopt a standard clinical practice guidelines for prone position in general ICUs including different ARDS patient.