Prone positioning in patients with acute respiratory distress syndrome, translating research and implementing practice change from bench to bedside in the era of coronavirus disease 2019.
Yogesh Apte, Kylie Jacobs, Shaun Shewdin and 4 others
PMID 33487546WHAT IT FOUND
Nine ICU patients with ARDS were turned face down after a quality improvement rollout; seven came off ventilators, one died, and three had grade 1 pressure injuries, with no major complications reported.
Key findings
0125 patients were diagnosed with ARDS and nine were placed in the prone position; the paper reports no major complications or adverse events associated with proning.
02Three patients developed grade 1 pressure injuries to the face, chest, and toes; seven were successfully weaned, one was resuscitated while prone and transferred, and one died.
03A formal audit during the first 12 months after introduction found inadequate surveillance and documentation of pressure injury prevention, leading to modified equipment and increased monitoring.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The paper reports a quality improvement project rather than a controlled trial, so the outcomes cannot show that the protocol caused the results. Only nine patients were placed prone, and the authors state the sample size was very small, so rare or delayed complications may be missed. The conclusion that proning is safe and effective is not tested against usual care. The initial audit found inadequate surveillance and documentation of pressure injury prevention, which may have affected early safety reporting. It was conducted in two nontertiary ICUs without extracorporeal membrane oxygenation, so it may not apply to units with different resources.
Declared interests
The authors declared no conflict of interest. No funding source is stated in the supplied text.
The easy way to misread this
Do not read the seven weaned patients as evidence that proning caused recovery. This is a quality improvement report, not a controlled trial, and only nine patients were proned. Three patients developed grade 1 pressure injuries.