Home » Guidelines » Prone Ventilation in Critical Care
Prone ventilation in patients with ARDS improves oxygenation and has been shown to improve mortality; especially if implemented early in the ventilatory deterioration. It is the only hypoxemic rescue intervention with evidence base for mortality improvement. It is postulated that proning improves gas exchange in a multifactorial fashion including ventilation of the anatomically largest part of each lung & removal of the cardiac compression of the left lung.
Repeat the procedure for the turning process.
About 60-70% of patients show an improvement in oxygenation when placed prone. Some are early responders (less than 30 minutes to show an improvement in PaO2) and some are late responders
It is not uncommon for the patient to transiently worsen following the turn. This is likely due to changes in pulmonary blood flow and secretion mobilization. The situation usually improves within 2 hours.
Recent studies have shown improvement up to 17 hours with prone ventilation. The duration of proning shown be dictated by the individual patient’s response but should ideally be less than 20 hours.
If there is no response to prone ventilation after 4-6 hours, consider placing supine again Failure of PaCO2 levels to fall following proning is a poor prognostic sign.
Ceylon College of Critical Care Specialists