Automated Prone Positioning and Axial Rotation in Critically III, Nontrauma Patients With Acute Respiratory Distress Syndrome (ARDS)


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Abstract

The objective of this study was to evaluate the use of kinetic therapy beds for automated prone positioning and axial rotation in critically ill nontrauma patients with acute respiratory distress syndrome (ARDS). There were 17 patients with ARDS who underwent automated prone positioning using a kinetic therapy bed. The mean age was 51 ± 14 years; 12 were females and 12 were Caucasian. The most common admission diagnosis was sepsis (n = 5). The mean Acute Physiology and Chronic Health Evaluation (APACHE) 2 score was 30 ± 9 with mean predicted mortality of 65% ± 25%. At the time of prone positioning, all patients met the criteria for ARDS. The mean ratio of Pao2 to Fio2 (P/F ratio) before initiation of prone positioning was 89 ± 33 and rose to 224 ± 92 after at least 30 minutes of prone positioning (P < .0001). There was no significant change in Paco2 or mean airway pressure. There were no instances of accidental endotracheal tube and central or peripheral venous or arterial catheter dislodgement. Eleven (65%) patients developed new pressure ulcers, 10 (59%) patients developed new skin tears, and all had conjunctival edema during the course of prone positioning. The median duration of automated prone positioning was 6 (interquartile range [IQR] 3.5–8.5) days. Eleven (65%) patients died during hospitalization and 7 required percutaneous tracheostomy for long-term ventilator support. Automated prone positioning using a kinetic therapy bed is a safe and effective means of improving oxygenation in critically ill patients with ARDS. Larger randomized studies are needed to compare it to conventional ventilation strategies, conventional prone positioning, and to assess the impact on mortality.

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