Patient and Family Information
Is your loved one a candidate for prone (face down) positioning? Here is some information about prone positioning and how it can help oxygenation, and the Pronova-O2™ Automated Prone Therapy System and its benefits.
What Is Respiratory Failure?
Respiratory failure is a condition that occurs when the lungs are not exchanging enough oxygen and carbon dioxide. Respiratory failure often requires mechanical ventilation (a ventilator) to supplement oxygen and carbon dioxide exchange when the body is unable to do this alone.
Many different conditions can cause respiratory failure such as: sepsis, pneumonia, trauma, COVID-19, and the flu, among others. Acute respiratory distress syndrome (ARDS) is a general term often used to describe respiratory failure. This syndrome causes fluid to fill the lungs, making it difficult or impossible to exchange oxygen and carbon dioxide. This lack of oxygenation can deprive other essential organs of the oxygen they need to function, such as the liver, kidneys, and brain. Often with ARDS, advanced medical interventions are used, such as prone positioning.
Benefits of Prone Positioning
Improves oxygenation:
The prone position increases oxygen and carbon dioxide exchange by removing fluid in the alveoli (tiny air sacs in the lungs). Lungs are filled with millions of alveoli that work to exchange oxygen and carbon dioxide with the blood as you breathe. More alveoli are located at the bottom of your lungs closer to your spine, so when you lie on your back (supine), your heart and other organs press down on that lower area of your lungs, making it harder for that part of the lung to expand.
In addition, when you lie supine for an extended period of time, gravity causes fluid to fill in the lowest part of the lung, which is where the largest amount of alveoli are. During respiratory failure, this pressure and buildup of fluid can cause the alveoli to collapse and no longer be able to exchange oxygen and carbon dioxide. When you move into the prone position, gravity works in your favor to help release fluid from the alveoli and open up a larger surface area in the lungs, for compressed alveoli to reopen and be able to exchange oxygen and carbon dioxide, improving oxygenation.
Reduces the effects of pressure on the lungs:
The weight of the heart and abdomen on the lungs is relieved in the prone position. This allows the patient’s lungs to expand more easily. The prone position also allows pressure from the ventilator to be distributed safely to the lungs, preventing the harmful effects of ventilator-induced lung injury.
How Pronova-O2™ Works
The Pronova-O2 Automated Prone Therapy System was developed with you and your loved one in mind. This system provides an effective and efficient way for clinicians to safely move a patient into the prone (face-down) position while allowing the patient to be gently and continuously rotated from side to side (continuous lateral rotation). This protects patients from many of the risks associated with manual prone positioning.
Things to Keep in Mind
Edema (swelling) often becomes very noticeable in the face and tongue from prolonged prone positioning. This swelling is common and expected as the face is lying in a lowered position while prone. Keep in mind that this swelling is temporary and typically resolves over time once recovery begins and prone positioning time is reduced.
Skin breakdown is a common risk factor for patients who are in the prone position in the ICU. We created the InteliDerm™ Powered Skin Protection System to reduce skin breakdown risk on the face and chest for patients on the Pronova-O2 Automated Prone Therapy System.
Visibility of the patient may be limited while they are in the Pronova-O2 system. Discuss options with your nurse to feel better connected to your loved one during this time.
Common conditions
that cause ARDS
- Pneumonia
- Sepsis
- Major trauma
- Aspiration of harmful substances
What can you do?
- Ask questions
- Journal
- Talk to your loved one
- Ask the nurse how you can help with any care
- Look for support groups (ARDS Foundation, American Lung Association, etc.)
ICU Terms
Visit MyICUGuide to learn more about ICU terms and treatments.
Arterial blood gas (ABG) is a blood test that measures oxygen and carbon dioxide levels in your blood. This is usually drawn through an arterial line, typically located near the wrist or femoral artery. The arterial line provides a constant measurement of the patient’s blood pressure.
Bronchoscopy is a procedure that provides a close look inside the lungs. It allows the physician to suction and test fluid in the lungs.
Intubation is a procedure to insert a breathing tube into the lungs to provide mechanical ventilation breathing support to assist in oxygen and carbon dioxide exchange.
Mechanical ventilation is a machine that takes over the work of breathing when a patient cannot breathe on their own, most often in instances of respiratory failure.
Paralytics and Sedation are often used in the care of critically ill patients requiring mechanical ventilation, to ensure comfort of the patient and to assist with treatments and interventions.
SpO2 (Pulse Oximeter) displays a percentage from 0–100 that is constantly shown on the monitor. It is a measure of the oxygen saturation in the blood.
Sources:
Hadaya J, Benharash P. Prone Positioning for Acute Respiratory Distress Syndrome (ARDS). JAMA. 2020;324(13):1361. doi:10.1001/jama.2020.14901
ARDS. Mayo Clinic. Retrieved April 9, 2020, from https://www.mayoclinic.org/diseasesconditions/ards/diagnosis-treatment/drc-20355581?p=1
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