Proning

Medical technique used to improve oxygenation

Proning is a medical technique that involves placing a patient in the prone position, which means lying on the stomach. This position is used primarily to improve oxygenation in patients with acute respiratory distress syndrome (ARDS) and other conditions that impair breathing. Proning has gained significant attention as a therapeutic intervention, especially during the COVID-19 pandemic.

Mechanism

Proning works by redistributing blood and air flow in the lungs. In the supine position, the weight of the heart and abdominal organs can compress the lungs, particularly the dorsal regions, leading to atelectasis and impaired gas exchange. By turning the patient onto their stomach, these effects are mitigated, allowing for better ventilation-perfusion matching and improved oxygenation.

Procedure

The process of proning a patient involves several steps to ensure safety and effectiveness:

1. Preparation: Ensure all necessary equipment is available, including pillows, sheets, and monitoring devices. The patient's vital signs should be stable before beginning the procedure.
2. Positioning: Carefully turn the patient from the supine to the prone position. This often requires a team of healthcare professionals to ensure the patient is moved safely and that all tubes and lines remain secure.
3. Monitoring: Continuously monitor the patient's oxygenation, heart rate, and other vital signs. Adjust the position as needed to maintain comfort and effectiveness.
4. Duration: Patients may remain in the prone position for several hours at a time, depending on their condition and response to the intervention.

A patient in the prone position

Benefits

Proning has been shown to improve oxygenation and reduce mortality in patients with severe ARDS. By enhancing lung mechanics and gas exchange, proning can lead to better clinical outcomes. It is particularly beneficial in cases where conventional ventilation strategies are insufficient.

Challenges and Considerations

While proning is beneficial, it is not without challenges. Potential complications include pressure sores, facial edema, and difficulties with airway management. Careful attention to positioning and regular monitoring can help mitigate these risks.

Use in Neonates

Proning is also used in neonatal care, particularly for infants with respiratory distress. The technique can be adapted for use with neonates, taking into account their smaller size and specific needs.

File:Neonate with electrical impedance tomography electrodes.jpeg

A neonate with electrical impedance tomography electrodes, used in respiratory monitoring

Related pages

• Acute respiratory distress syndrome
• Mechanical ventilation
• COVID-19 pandemic