Proning
Lying PRONE is when we place a ventilated patient on to their front. The process of getting a patient onto their front is known as Proning.
Prone ventilation has been used for many years to improve oxygenation in the management of the critically unwell patient with Acute Respiratory Distress Syndrome (ARDS) (MacDonald and Armstrong, 2000). The physiological benefits of prone ventilation have been well described: with improved ventilation-perfusion mismatching, recruitment of dependent lung regions and enhanced drainage of tracheobronchial secretions.
Available evidence suggests that prone positioning must be considered early in the disease process of ARDS and acute lung injury.
The optimal duration of prone ventilation has not been identified; however there is meta-analysis study (Beitler, Shaefi, Montesi at al 2014) to suggest a fall in mortality in patients ventilated in the prone position for over 12 hours. It is therefore recommended to prone patients for a period of at least 12 hours up to 24 hours, ideally coordinating the periods of turning with increased numbers of medical and nursing staff.
The Collaborative Benchmarking Group have produced Best Practice Guidance and a Proning Checklist for use when turning a patient prone. There is also a Relative/Carer Information leaflet to explain why we are turning their loved one prone.
| Proning Best Practice Guideline & Checklist 2017 |
| Relatives Information on proning |
| ICS/FICM Proning Guidance Final 2019 |
Watch this YouTube clip on how to turn your patient prone.