Cite this post as:
Scott Weingart, MD FCCM. Podcast 124 – The Logistics of Proning for ARDS. EMCrit Blog. Published on May 18, 2014. Accessed on January 21st 2022. Available at [https://emcrit.org/emcrit/logistics-proning/ ].
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Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.
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Great podcast Scott! Adds an extra resource to my effort to make this a safe option in my ICU
I’m curious about one point still…
If an emergency occurs while the pt is prone, such as cardiac arrest or dislodgement of the airway, how does the procedure differ in order to flip the patient onto their back within seconds, when you don’t have the benefit of time for meticulous preparation? There is a tenuous balance of spending extra seconds on communication and safety vs cracking on and dealing with the emergency.
protect the ETT and flip. should take a few seconds. try to save the lines, but they are not a priority. now the ecmo cannulae can kill a pt if they dislodge, so risk benefit obv. favors protecting those as well as the ETT.
Hi Scott Firstly, I’m a fan of proning, used to do it quite often in a non-ECMO center and never had any issues, just requires meticulous teamwork and surveillance for problems. Not sure about the advice to do proning ‘early’ – what is meant by ‘early’? The evidence for benefit is in the moderate-severe ARDS group (PF ratio <150) – I wouldn't advocate proning if this is not met. Regardless of any theoretical rationale (most of our physiological explanations for things are probably pseudo-mythological), it is not supported by the literature IMO (e.g. PROSEVA, preceding meta-analyses). I was surprised by… Read more »
Chris, let’s find a few minutes and do a wee together re: this
Hi Scott,
I can’t seem to get the physiology of proning link to load. Anybody else having problems with this? Thanks.
fixed now; thanks Garrett and Mike.
Looks like emcrit’s link to that physio study got mangled, here’s what it looks like he was aiming for: http://www.erj.ersjournals.com/content/20/4/1017.full
Seems like chair or sitting position would be a lot easier for management (accessing lines, oral care, etc), and in the case of emergency, easier to start resuscitation. Is there a study on supine vs. prone vs. sitting position for lung recruitment in ARDs?
abd contents push up against the lungs in these positions quite dramatically. At STC, bad lungs with bad brains get nursed standing up.
Hi Scott, Just listened to this podcast for the umpteenth time. Very helpful and informative and has helped me no end with ventilation strategies in a department not equipped with the resources to attempt prone ventilation. I will certainly be suggesting my consultants look into these great statistics.
Regards Rob Owens (Registered Nurse).
thanks Rob
excellent Scott, and Joe Tonna.
I’m six years late as usual. but still, excellent pod.
tom