Summer trauma insights: The role of automated proning
By Tara Psencik, BSN RN
As temperatures rise and people spend more time outdoors, trauma centers across the country prepare for what many clinicians refer to as “trauma season.” The summer months consistently bring an increase in motor vehicle collisions, motorcycle accidents, recreational injuries, drownings, falls, and violence-related trauma.¹˒² Emergency departments and intensive care units often experience a significant surge in critically injured patients during this period.
While the initial injuries frequently receive the most attention, one of the greatest challenges trauma teams face occurs after admission: respiratory failure.
The Hidden Threat After Trauma: Respiratory Distress
Severe trauma can trigger a cascade of physiological responses that place patients at high risk for respiratory complications.³˒⁴ Pulmonary contusions, chest wall injuries, aspiration, massive transfusions, systemic inflammation, sepsis, and prolonged mechanical ventilation can all contribute to worsening lung function.
Many trauma patients develop acute hypoxemic respiratory failure requiring advanced ventilatory support. In the most severe cases, patients progress to Acute Respiratory Distress Syndrome (ARDS), a life-threatening condition characterized by diffuse lung inflammation, impaired gas exchange, and refractory hypoxemia.⁵˒⁶
ARDS affects thousands of critically ill patients each year and remains a significant cause of mortality in trauma populations.⁷˒⁸
Prone Positioning: The Standard of Care for Moderate to Severe ARDS
Over the past decade, prone positioning has become one of the most evidence-based interventions for patients with moderate to severe ARDS.⁹˒¹⁰
By turning patients from their back onto their abdomen, prone positioning improves ventilation-perfusion matching, recruits collapsed alveoli, reduces dorsal lung compression, and promotes more uniform distribution of mechanical ventilation.⁹˒¹¹˒¹² Clinical studies have demonstrated significant improvements in oxygenation and survival when prone therapy is applied appropriately and for sufficient duration.⁹
Today, major critical care guidelines recommend prone positioning as a standard of care for patients with moderate to severe ARDS.¹³˒¹⁴
The Challenges of Manual Proning
Manual proning is a labor-intensive procedure that typically requires five to seven caregivers working in coordinated fashion.¹⁵ During each turn, clinicians must manage multiple lines, tubes, monitoring cables, and the endotracheal tube while simultaneously protecting the patient from injury. The process introduces multiple risks including:
- Accidental extubation
- Dislodgement of central lines and drains
- Staff musculoskeletal injuries
- Pressure injuries
- Delays in initiating therapy due to staffing limitations
- Variability in positioning technique
For busy ICUs already managing high-acuity trauma patients, these challenges can create barriers to delivering timely and consistent prone therapy.
A New Approach: Automated Proning with the Pronova-O2®
Automated proning technology is helping healthcare teams overcome many of the limitations associated with manual turning. The Pronova-O2® was developed to simplify and standardize prone therapy while enhancing safety for both patients and caregivers.*
References
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6. Thompson BT, et al. N Engl J Med. 2017;377(6):562-572.
7. Bellani G, et al. JAMA. 2016;315(8):788-800.
8. Rubenfeld GD, Herridge MS. Chest. 2007;131(2):554-562.
9. Guérin C, et al. N Engl J Med. 2013;368(23):2159-2168.
10. Scholten EL, et al. Chest. 2017;151(1):215-224.
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12. Munshi L, et al. Ann Am Thorac Soc. 2017;14(Suppl 4):S280-S288.
13. Fan E, et al. Am J Respir Crit Care Med. 2017;195(9):1253-1263.
14. Papazian L, et al. Ann Intensive Care. 2019;9(1):69.
15. Intensive Care Society. Guidance for Prone Positioning in Adult Critical Care.
