How to Effectively Use Prone Position ?

Post in Health

Prone positioning is used since 1970s to improve oxygenation of patients with acute respiratory failure. Proning is a position under postural drainage of bronchial hygiene technique. It is accepted medically to improves oxygenation and ventilation perfusion. It is noted to be beneficial in patients suffering from COVID-19 or patients having altered lung compliance, have compromised respiratory systems, secretion in lungs etc.  Also, it is very helpful during home isolation.

 

Procedure

Turn the patient safely from back to abdomen (stomach). Make them lie on their stomach. Make them stay for at least 20-30 minutes.

 

Significance of Prone Lying

  1. Prone positioning seems to improve oxygenation.
  2. Provides more uniform ventilation.
  3. Decreased risk of atelectasis
  4. Reduction in pleural pressure.
  5. Improves minute ventilation.
  6. Reduced abdominal pressure on the thoracic cavity.
  7. Promotes postural drainage, helps in removing secretions from the lung.
  8. Improves ventilation perfusion.
  9. Improves alveolar perfusion
  10. Reduces hip flexion contractures.
  11. Reduces ventilation and hospital stay.

 

Mechanism

The mechanism of action appears to be a reduction of compressed lung segments by the heart, recruitment of collapsed lung tissue by re-expansion of dependent consolidation as it shifts from dependent to nondependent positions, and improved gravity-related drainage from previously dependent consolidated lung tissue, all resulting in improved matching of ventilation to perfusion (Ref: Crit Care Med. 2000;28(2):572-574., Dupont H, Mentec H, Cheval C, Moine P, Fierobe L, Timsit JF.)

Prone Positioning with the help of pillows

First Pillow: One pillow must be placed below the neck.

Second Pillow: Place 1 or 2 pillows below the chest.

Third Pillow: Place a pillow under the upper thighs.

Fourth Pillow: 2 pillows must be placed below shins.

 

Cautions to be taken

  1. Do not opt proning immediately after meals.
  2. Prone position can be opted for 16 hours at maximum a day.
  3. Proper use of pillows must be used to reduce pressure on bony areas.
  4. Regular check for pressure sores or any injuries, around the bony prominences.

 

Contraindications

  1. DVT- Deep venous thrombosis
  2. Pregnancy
  3. Cardiac Anomalies
  4. Hypertension
  5. Any instability of the spine
  6. Any injury to the femur, or pelvic girdle fractures, etc.