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Critical Care |

Safe Implementation of a Manual Proning Protocol for ARDS: A Case Control Analysis

Damien Patel; William Carlos
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Indiana University School of Medicine, Indianapolis, IN


Chest. 2014;146(4_MeetingAbstracts):208A. doi:10.1378/chest.1987849
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Abstract

SESSION TITLE: ARDS/Lung Injury Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Despite increasing knowledge about the pathophysiology of acute respiratory distress syndrome (ARDS) treatment options are limited. Management continues to center on supportive care. Recently, the PROSEVA Study Group published data on a large, randomized control trial of severe ARDS having a mortality benefit from early, prolonged, manual pronation therapy. One major criticism of this study was the years of local expertise with prone positioning and lack of generalizability to other intensive-care-units with less experience. To our knowledge, in the United States, there is limited data on manual proning. At our institution we implemented a standardized protocol for early manual pronation of ARDS patients to evaluate feasibility and safety.

METHODS: A retrospective chart review was used to identify severe ARDS patients (P/F <150 mm Hg) who underwent manual pronation at two, academic center ICU’s at our institution. These patients were matched to a similar historical cohort of ARDS patients in a case-control study based on age, gender, weight, etiology of ARDS, and baseline P/F ratio. Primary end points were safety and complications of manual prone positioning.

RESULTS: Between September 2013 and March 2013, we identified all ARDS patients who were treated with manual prone positioning. Eight patients who received manual prone therapy were then compared to a similar historical cohort from retrospective chart review. We reviewed medical records for any complication associated with prone positioning. Pneumothorax, hypotension, and ventilator-associated pneumonia were identified. However, problems with endotracheal tubes, venous catheters, and pressure injuries did not occur.

CONCLUSIONS: Early, prolonged application of manual proning in patients with severe ARDS seems safe based on analysis of our small cohort. The creation of a standardized protocol along with physician and nurse-driven education is paramount to safety.

CLINICAL IMPLICATIONS: Institutions unfamiliar with prone positioning should not view their lack of experience as a barrier to implementation of a therapy that has been shown to improve oxygenation and mortality. Our study adds further evidence to the growing body of literature supporting the safe use of manual pronation in severe ARDS.

DISCLOSURE: The following authors have nothing to disclose: Damien Patel, William Carlos

No Product/Research Disclosure Information


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