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Correspondence |

Prone Positioning?: Remember ABCDEFG FREE TO VIEW

Milind Baldi, MD; Inderpaul Singh Sehgal, MD, DM; Sahajal Dhooria, MD, DM; Ritesh Agarwal, MD, DM
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India

CORRESPONDENCE TO: Ritesh Agarwal, MD, DM, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1184-1185. doi:10.1016/j.chest.2017.02.023
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Published online

We read with interest the article “Treatment of ARDS With Prone Positioning” wherein the authors summarize the physiological principles, clinical evidence, and practical application of prone position ventilation in ARDS. Prone positioning entails an increased risk of complications, including pressure sores, endotracheal tube displacement, loss of venous access, and others. Girard et al compared the incidence and severity of pressure ulcers in the participants of the Proning Severe ARDS Patients (PROSEVA) trial and highlighted the need for active prevention of pressure sores in patients who are put in a prone position. At the time of placing a patient with ARDS in the prone position, a few important precautions should be taken, which are essential to minimize the hazards of prone positioning.

We suggest a practical aide-memoire (ABCDEFG) that can be used as a “prone positioning bundle” and checked every time a patient is placed in the prone position (Table 1). This checklist provides “to dos” before and immediately after prone positioning.

Table Graphic Jump Location
Table 1 ABCDEFG of Prone Positioning

References

Scholten E.L. .Beitler J.R. .Prisk G.K. .Malhotra A. . Treatment of ARDS with prone positioning. Chest. 2017;151:215-224 [PubMed]journal. [CrossRef] [PubMed]
 
Park S.Y. .Kim H.J. .Yoo K.H. .et al The efficacy and safety of prone positioning in adult patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. J Thorac Dis. 2015;7:356-367 [PubMed]journal. [PubMed]
 
Girard R. .Baboi L. .Ayzac L. .Richard J.C. .Guerin C. . Proseva Trial Group. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014;40:397-403 [PubMed]journal. [CrossRef] [PubMed]
 
Guérin C. .Reignier J. .Richard J.-C. .et al Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-2168 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 ABCDEFG of Prone Positioning

References

Scholten E.L. .Beitler J.R. .Prisk G.K. .Malhotra A. . Treatment of ARDS with prone positioning. Chest. 2017;151:215-224 [PubMed]journal. [CrossRef] [PubMed]
 
Park S.Y. .Kim H.J. .Yoo K.H. .et al The efficacy and safety of prone positioning in adult patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. J Thorac Dis. 2015;7:356-367 [PubMed]journal. [PubMed]
 
Girard R. .Baboi L. .Ayzac L. .Richard J.C. .Guerin C. . Proseva Trial Group. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014;40:397-403 [PubMed]journal. [CrossRef] [PubMed]
 
Guérin C. .Reignier J. .Richard J.-C. .et al Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-2168 [PubMed]journal. [CrossRef] [PubMed]
 
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