Proning the ARDS patient- why do we do it?
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- čas přidán 9. 07. 2024
- There are lots of videos on CZcams showing us how to prone but not so many telling us why. This is my attempt to explain many of the reasons why it is considered worthwhile.
There are many more resources on my Online Teaching School at criticalcarepractitioner.podi...
I have based much of this from two papers which I would recommend you read if you want more depth.
Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review- www.wjgnet.com/2220-3141/full...
A Comprehensive Review of Prone Position in ARDS- www.ncbi.nlm.nih.gov/pubmed/2...
I also refer to the American Thoracic guidelines for managing the ARDS patient which can be found here- www.thoracic.org/statements/r...
I also have courses for you on NIV, Intubation and Anatomy of the airway at critical-care-practitioner.te...
I have more resources for you to look at on my website at:
www.criticalcarepractitioner.co.uk
You can also access my podcasts in iTunes 'Critical Care Practitioner'
This was posted almost exactly two years ago. Look at all of us boning up on our pulmonary physiology during the pandemic. Crazy times. Thank you Jonathon!
Be well everyone!
Can they actually turn a patient on their stomach in the hospital bed though? What about all the stuff they have connected?
Guilty!
@@sl4983 It is possible and employed, but needs a coordinated well trained team of at least 3 members.
@@sl4983 They were doing it in china with better affect.
Are ventilators connected to 60 GHz powering (5G)?
The best articulated and explained lecture on Prone ventilation I’ve heard! Thank you!
I agree. Excellent! But please get a better microphone, please!
I'm sorry, I didn't understand a word of it. I'm not a doctor.
This is the most helpful and easiest explanation of this topic I've ever seen, kudos sir!!! Thanks for making this
as a soon to be respiratory therapist this was an amazing explanation of the rationale and physiology of why proning is so beneficial. thank you for this great content.
Neonatologist here. I also tend to think that in babies prone positioning drops the abdominal organs, allows larger diaphragmatic excursion, and that increases (potentially )lung volumes
Essential info these days .Excellent explanation .Thank you .
Brilliant video: simple, concise, no-"water".
Thank you very much!
You're welcome!
Great new blog Jonathan. Helped me understand the mechanisms involved much better than I previously did by just reading the literature alone. 👌👌👌
Scott Hawkins thanks Scott. Had to record this twice having screwed it up the first time so glad it is useful.
Well explained!Thank you for sharing i understand more the pathophysilogy of prone positioning and including the list of literature. I need it for my revisions.
Great video! I’m a new adv care practitioner in US and your videos are very helpful and informative!
The best ARDS explanation and proning!! Covid 19 lungs are similar and some are put on a rotopron bed
sars 2 can cause ARDS
I adopted the prone position when I had flu in November 2018. I lay on my front with my head over the edge of the mattress, because the mucus that was running into my chest was making me cough and it was becoming very painful. It took me several weeks to recover with the help of some anti-biotics. From a lay-mans point of view it seems a practical method to get the fluid out of the lungs to have your head at a lower level whilst lying on your front.
Excellent explanation, thank you!
After seeing your presentation here...I'd happily work with you in a heartbeat...excellent grasp of the entire thing!
Thank you. That's very kind. More coming soon!
Thank you so much for your video from Madrid. Including the list of scientific papers.
Great information. Thank you .
Thank you very much! From Sri Lanka🇱🇰
This helped so much! thank you
Hi Jonathan, thank you for the great explanation. I had a patient who was COVID +ve, and had a LT lower lobe collapse, supine CO2 was 12. What would be the cause of this ?
When would you consider proning to be a contraindication ?
very good video, sir, thank you!
Thanks, nicely explained..👍🏼
Thank you, glad it helped.
Thanks for the excellent explanation and presentation!
Glad it was helpful!
This is fascinating and very helpful!
Concidering corrent sanitary emergency and the fact that many people don't gets the ventilator witch are the downside of start prone the patient between 250 p/f and 150 p/f. Concidering that studies like proseva have show the best result close to 150 p/f ( but i dont find data about proning before) . today a small change that make a small improvement in the survival rate of covit 19 it will mean thousands of lifes
I had a bad cold or flu last week and for 1.5 hours while I was trying to sleep on my back I was constantly coughing and I had a lot of gurgling and bubbling of fluid in my lungs. I've had that before so I was not alarmed but it was distressing to think I had the whole night ahead of me. I flipped over to sleep on my stomach and ALL of the bubbling and gurgling in my lungs went away and the coughing reduced to near zero. I was shocked at how dramatic the change was. I was basically able to sleep the rest of the night. I also slept on my stomach the 2nd night, though I had a little bit of coughing but I was eventually able to sleep most of the night. To sleep on my stomach I sleep with my head on the edge of the pillow so my face is angled slightly down and I prop up my shoulder with 3 folded towels and I also lift my hip on that same side with a crumpled up bedsheet. This reduces the amount of neck rotation needed to sleep on my stomach. Another trick is to add something to keep your head from sliding off the pillow. It's hard to describe but basically I use pillowcase with the T-shirt in the end of it that sticks out from under my pillow and that creates a stop (like a wedge) to prevent my head from sliding off the side of the pillow. I've worked out these tricks for sleeping on my stomach over the past 2 years because I find stomach sleeping helps me sleep a lot better. I'm 57 years old and turning my head to the side to sleep on my stomach is more difficult than a younger person, so these methods reduce the amount the head needs to be turned for stomach sleeping.
Thanks! Could you please discuss these same factors as found in a patient who is primarily sitting or reclining? As might be found during typical hospital care or home illness. Would patients dealing with some form of respiratory stress/distress be well served by adopting a prone position?
Good question
Can you review the “Odom Ultra flu A&B testing ?? Instructions on collecting samples. Also instruction on collecting strep testing ?
I just subscribed after your lecture on supine/prone ARDS, brilliant!!
FreakING bad ass lecture from an ICU CCRN. Thank you doctor!!!!!!!!!!!!!! Respect respiratory!!!!!!
Thank you for this information. My Brother In Law will be in a ROTO-BED in a few hours. 13 days with A(H1N1) and complications from the double pneumonia. This has to save him. Praying for his recovery.
Update? My grandmother is in ICU with double pnemonia and they are putting her in a roto bed today
Hope everything went well
PRAYING TOO
Thank you!
3:20 was the most helpful part.
Thank you, sir.🤠😊👍🏽🇺🇸
The positioning of the arms may be helpful also. When I raise my arms, it calms my bronchospasms...I learned to do this via a family that always tells kids when they are choking on food to raise their arms.
Hello Jonathan. Do you Know a consensus? Or which Is you opinion about when to stop prononing? 3,4,5..8,9 data?
How smart do you feel right now having posted this 2 years ago?
Thanks ❤️
RE CoVid patients: Does forward or backward tilting of the patient in the prone position help with fluid in the lungs control; and, will diuretics help remove some of the lung fluids? Non-medical, non-engineer inventor. Have read Richtel's : "An Elegant Defense" 5 times though. Based on that, Dr. Fauci has a known plan for developing a therapeutic, I believe.
Anluer said we sit jp when chest infevtions and i asked about whh ventilators were set so low and ...nio answer .later i saw tbwt increase of acudosis yet optimum penstrayion for crona is pH 5:5 yet it t flourishes at lower pHs too because a idif solutions dont kill it off sp is sitting pstiejtz up with chest infectionz only wben no ARDS ?sitti g patie ts up in hrart failure vhest infectinz what hhdb do.
Great explanation. Anaes doc.
Can we use this in covid problem
You seem to know a bit about lungs. For people with mild dyspnea. Are there movements to help massaging alveolis and improve oxygenation ? I move my shoulders to modify my chest shape and it feels better (now how much is placebo..? hence my question).
Johan PONIN interesting question!
I wonder if you'd address methods of lying prone. An obese person has difficulty lying prone. What is your practice in that case?
Will it help a corona patient not yet in resp. Distress? Patient is feverish x 30 days. No sob. On abx but not improving. Diabetic x 30 years uncontrolled.
excellent
Do hospitals and doctors do this though?
Did you take into account the weight of the spine and back muscles? Do you need higher airway pressures? What about the personnel needed to keep turning the patient?
Review Respiratory Anatomy and Physiology...
@@MarshaNHill how many prone ventilation have you seen or done yourself?
Thanks for the explanation. But I have a question. What if an ARDS patient had a cardiac arrest during prone ventilation, will you attempt to perform CPR while the patient is in the prone position?
Depends on airway. If not intubated turn over ASAP. If intubated do CPR prone; there is evidence it is just as effective. See guidance on cardiac arrest during neurosurgery which covers this quite well. t.co/ySanGXUwbL
Great graphic education, thank you but please what is a 'slinky'????
The toy made out of a thin flexible spring.
Basically a coil.
I'm afraid there is a mistake. In the supine position the dorsal alveolis, at reast, are smaller and less expanded then the vental ones, but this means that during the inspiration the dorsal alveolis (with the same pressure variation) have a greater expantion in comparison with the ventral ones. Therefore the dorsal region is better ventilated then the ventral region
And I still don't understand why in ARDS the the prone position improve the V/Q ratio
Just found out my Aunt was placed in one of these to try and treat her for Covid-19. The medications they tried didn't work so now they're trying this.
I hope she has improved
It's really hard to follow without ample illustrations, and explanation of technical terms, at least to me as a layperson in these matters...
On the MedCram CZcams channel, there's excellent info, with diagrams, for healthcare workers and also laypeople. This lecture from 2 months ago explains a lot about the virus, and also some about proning: How Coronavirus kills: Acute respiratory distress syndrome (ARDS) and COVID-19 treatment.
Hello Jonathan, I have COPD and am having surgery in the prone position. How safe is intubation in this position?
Very safe in experienced hands which I am sure you will have.
@@TheCriticalCarePractitioner Thank you. I was in the safest hands.
superb👍👍👍👍
Thank you! Cheers!
Question. If you incline the patient so their head is slightly lower than their feet while they are prone, will there be a better draining from the lungs? I seem to remember reading something about doctors doing this during the SARS outbreak in 2002, but I can't find any info about this. Would this be an option for serious cases for the current COVID19 outbreak?
I remember seeing this done years ago when I worked in hospitals as a college student. They called it postural drainage, and it was applied to several firefighters with pretty bad smoke inhalation. The treatment was more aggressive than mere positioning, and involved cupping percussion to the back. They had heads four inches lower than trunk, in prone position. The drainage, which was of course grossly discolored and pretty viscous, was profuse and production without undue effort.
@@manthasagittarius1 Getting the nasty stuff out of your lungs is always a good thing.
This is not about draining fluid from the lungs. It is to give the alveoli room to expand in areas with the best blood supply
@@TheCriticalCarePractitioner I had and still have been, reading stories about how COVID 19 patients lungs are being damaged by the bodies own attempts to fight the virus. Other stories talk about ICU staff turning the ventilators up very high because patients lungs are so full of fluid that their lungs can't absorb air properly. To me, it makes sense to put the patient in a position that allows gravity to drain the fluid out of their lungs so they can breath better.
Of course, I have no medical qualifications, none of my family or close friends have any medical qualifications. It would not surprise me if I am entirely wrong, which is why I asked my question.
Bravo
Noticed that in some news footages of some of the COVID-19 patients in a hospital ICU in Italy and they are placed in prone position. So the theory behind that is to allow phlegm and fluids to drain by gravity, and it is postural drainage in itself.
The theory appears to be also that the larger part of the lung is more evenly inflated with this method (thus better oxygenation, and removal of carbon dioxide), with less shearing force between the alveoli, thus less ventilator-induced damage if the patient needs to be on a ventilator for a long time (as many do with this virus). Please also see MedCram CZcams channel, which has excellent info for healthcare workers and also laypeople. This lecture from 2 months ago gives a good overview of 3 fairly recent advances in ventilation practices, including proning: How Coronavirus kills: Acute respiratory distress syndrome (ARDS) and COVID-19 treatment. I was curious about that footage from Italy too, and the MedCram lecture explained it perfectly for me. Lots of other great info about the virus there, too.
This is not about draining fluid, rather about giving the alveoli room to expand in areas which have the best blood supply
wht if they start standing patients up
How about putting bed in cardiac chair position.
Would it be more helpful to have the patient on their belly with their hips being higher than their shoulders?
My opinion is that it will be much better to lower the head end of the patient's bed by about 10 degrees so that the lungs can drain with the help of gravity naturally in the supine position, in much the same way as one would do with a recovering drowning person. A mixture of a few % alcohol in the patient's inhaled gas would help to break up sticky mucus, ease stress on alveoli and reduce infection.
All this work in this vid cited as good, credible med practice is fine, but it makes patients look as if they are on a spit roast.
Still, its better than a course of leeches.
I would like to add here that as a chronic sufferer of bronchitis, asthma and emphysema for 50 years, I found early that the above worked well to ease my symptoms and quickly restore normal breathing from chronic struggle. For my self-treatment, I used to heat up vodka in a pan and inhale the vapour with a towel over my head for a few minutes, then lie with my head over the end of the bed for a while to drain my lungs, and repeat until I felt somewhat better.
It worked and still does, or I would not have done the same all these years without the need for medication.
That is what happens when you live in traffic pollution centre London. Matey.
Hi, can I have a request? For the sake of emergency response on Pandemic situation and the upcoming 2020 CPR Guidelines, can you upload CZcams videos on how to manage a Prone Ventilated Asystolic (cardiac arrest) patient using Prone CPR simulation? Majority of CPR mannequin simulation for Asystolic CoVid-19 patients on CZcams are Really Disappointing, in which they NEVER did a CPR simulation on a patient undergoing prone ventilation since hospital staffs around the world are trained to do PRONING.
Win Si thx for posting your comment. I didn’t not realize you could perform CPR on a prone pt. I thought they had to be supinated first. But your question had me look it up and get some valuable information. Now I’m interested in a video
Kay In what video are you interested?
Severe C-19 ARDS -> Cardiac arrest -> No CPR ????
Ventilator Induced Lung Injury...Okay people need to know this!!
Yes, it's well known. Please see MedCram CZcams channel, very good info for healthcare workers and also laypeople. This lecture from 2 months ago explains it very well: How Coronavirus kills: Acute respiratory distress syndrome (ARDS) and COVID-19 treatment.
@@patriciamorgan6545 MedCram, thank you
@@sl4983 👍👌
@@patriciamorgan6545 oh boy, are they connected to a 60 GHz system?
Maybe I missed it, but why not laying on the l/r- side? That would reduces the stress on the heart. Another thing is, when laying on the back to put both hands behind the head. That opens up the lungs.
No wonder why I sleep quickly on prone position!
I’m here because I noted the Italians had their ITU patients prone during the COVID19
Besides draining, the theory appears to be also that the larger part of the lung is more evenly inflated with this method (thus better oxygenation, and removal of carbon dioxide), with less shearing force between the alveoli, thus less ventilator-induced damage if the patient needs to be on a ventilator for a long time (as many do with this virus). Please also see MedCram CZcams channel, which has excellent info for healthcare workers and also laypeople. This lecture from 2 months ago gives a good overview of 3 fairly recent advances in ventilation practices, including proning: How Coronavirus kills: Acute respiratory distress syndrome (ARDS) and COVID-19 treatment. I was curious about that footage from Italy too, and the MedCram lecture explained it perfectly for me. Lots of other great info about the virus there, too.
👍👌👍👌👍👌👍👌👍
If you are sick, by all means sleep on your stomach.
Wow, why don't I think most doctors in America don't know or practice this, especially now...
They do.
Yes, I'm sure they do.
Anyone else noticed Windows Vista in the background?
It's the SUJUD position ..
This is why bats hang upside down in moist and cold caves. This position protects the lungs more easily. Gravity helps the secretions.
Anyone else think their screen was scratched, below the cabinets? 😅
Actually it is the position of prostration we do in our 5-time daily prayers in Islam. God knows what is the best for us.
its called gravity. not god.
@@KubieQ yes right, it's gravity through prostration... and prostration is commanded by God.
You must have said great things.
But please realize that these days patients or their families also Google around to understand the situation and options.
So pls simplify for this kind of desperate audience too
Muslims do this 5 times a day on daily basis threw prayer (bowing their forhead down)
So proning is upside down planking. I see.
30 years working with ventilator patients. Never in prone position. Cannot see any advantage or practicality in the actual physical care. G.
I haven't made it to ICU yet, (The floor I currently work is IMCU/Covid19 unit), U say patients are never positioned in prone?
@ricky w. I’m a new graduate RN and I recently was in the ICU for a couple of months as a student and I saw a couple of patients on rotoprone bed therapy. While speaking to nurses on the unit, a couple had positive success stories with previous patients. It can really increase lung compliance. But I’m assuming with a lot of ARDS patients, it’s difficult to reverse. Just sayin, as a student I’ve seen it in south Florida🙂 I know though that patients sometimes get denied as a candidate for this therapy and ECMO. Best wishes and be safe!
@@alexandrasachlis1964 Nice, Ur orienting in ICU?
I appreciate you Gloria. Not like these dumb ass doctors that just because their licensed they think they can get away with murder.
Why don't they hang them up like bats in daytime?
Abdominal organs weigh on the diaphragm when I’m headstand position. Better if standing up.
@Lebensborn 2 oh, uh, yeah. I guess so. Seen Norm McDonald's video/song about eating bats? Very funny.
Concidering corrent sanitary emergency and the fact that many people don't gets the ventilator witch are the downside of start prone the patient between 250 p/f and 150 p/f. Concidering that studies like proseva have show the best result close to 150 p/f ( but i dont find data about proning before) . today a small change that make a small improvement in the survival rate of covit 19 it will mean thousands of lifes