Prone Therapy and Early Mobilization Article Review

By Allison Varnum

Immobility in critically ill patients leads to a range of negative outcomes such as ICU-acquired weakness (ICUAW), loss of muscle mass and function, and delirium followed by long-term cognitive decline and reduced quality of life. Electrophysiological changes in the neuromuscular system which lead to ICUAW have been noted to occur as early as 48 hours after ICU admission.

A panel of professional experts consisting of intensive care medicine, physiotherapy, nurses, surgery, rehabilitative medicine, and pulmonary medicine convened to create recommendations on positioning and early mobilization of critically ill patients.

This panel made some key recommendations on prone positioning for acute respiratory distress syndrome (ARDS) patients.

Prone Positioning Guidelines:

• Duration: a minimum of 12 hours daily with 16 hours as indicated in the PROSEVA trial is linked to improved oxygenation and increased survival rates
• Initiation: within 48 hours of mechanical ventilation improves mortality outcomes
• Low tidal volumes: recommended during prone positioning to improve outcomes
• Positive end-expiratory pressure (PEEP) optimization improves oxygenation

The study also provides evidence for early mobilization in ICU patients. Early mobilization shows significant benefits including:

• Reduced duration of mechanical ventilation
• Shorter ICU length of stay (LOS)
• Improved muscle strength and reduced incidence of ICUAW

Due to these findings, the panel suggested that mobilization of patients, including those with pre-existing conditions, should be initiated within 72 hours of ICU admission.

The Pronova-O₂™ Automated Prone Therapy System provides a safe and efficient method for passive mobility while positioning critically ill patients as well as aggressive mobilization of secretions in the prone position. For additional information on automated prone positioning, please visit turnmedical.com or call 1-855-275-8876.