Prone position
The prone position is a medical positioning therapy from the field of kinetic therapies .
This form of therapy is used for various types of lung failure , when the respiratory therapy does not provide adequate oxygenation of the blood .
Indications
The prone position should be used in severe acute lung failure when previous attempts to improve oxygenation have failed. On behalf of the German Society for Anaesthesiology and Intensive Care Medicine , guidelines for positioning therapy were drawn up. The prone position is recommended for patients with ARDS and life-threatening hypoxemia ( Horovitz quotient <150) (evidence level 1 a, recommendation level A). Prone position can also be considered in patients with ALI / ARDS and non-life-threatening hypoxemia (Grade 0 recommendation).
Acute lung failure can be triggered by: pneumonia , sepsis , mass transfusion , trauma , inhalation trauma , postoperative complications
Contraindications
Absolute contraindications to prone positioning are:
- acute shock syndrome
- unstable spine
- Bradyarrhythmia
- Lysis therapy
- heavy bleeding.
Relative contraindications to the prone position are:
- severe midface fractures
- acute / open abdomen
- unstable thorax
- Acute head trauma
Furthermore, z. B. Obesity o. Ä. Speak against the prone position, depending on which storage means are available. The prone position requires a doctor's order.
Mode of action
The prone position leads to a reduction in the pleural pressure gradient and thus to a homogenization of ventilation and pulmonary blood flow (improvement of the perfusion / ventilation ratio). In addition, the prone position improves the breathing mechanics, the dynamics of the diaphragm are increased and the reopening of the dorsobasal lung areas is promoted. This reduces the intrapulmonary shunt fraction . After a while, atelectases form in the ventral lung area in the prone position , but these are less dramatic and reopen without any problems after repositioning. The prone position also improves secretolysis . When the patient has been correctly rotated, the abdomen is exposed. This reduces the internal pressure in the abdomen and improves the mobility of the diaphragm.
The positive effect of the prone position can appear immediately after the repositioning or only after hours. The patient should spend 12 to 16 hours in the prone position to achieve a lasting effect. The measure should be carried out for at least four days in a row.
Risk factors
Dislocation of e.g. B. endotracheal tube or intravenous catheters , edema , damage to the position of the face , chest or knees . If resuscitation is required, the patient must first be turned back, which means a loss of time.
Alternatives to be mentioned are: nearside prone position (135 ° position), kinetic therapy in special beds that allow the patient to rotate continuously or even to rotate in the prone position (" sandwich beds ").