Proning the ARDS patient- why do we do it?

There are lots of videos on YouTube showing us how to prone but not so many telling us why. This is my attempt to explain many of the reasons why it is considered worthwhile.

I have based much of this from two papers which I would recommend you read if you want more depth.

I have more resources for you to look at on my website at:

You can also access my podcasts in iTunes 'Critical Care Practitioner'

[AnitaBetterScreenname]

This was posted almost exactly two years ago. Look at all of us boning up on our pulmonary physiology during the pandemic. Crazy times. Thank you Jonathon!
Be well everyone!

[Spiritual-journey]

The best articulated and explained lecture on Prone ventilation I’ve heard! Thank you!

[mervynsfontillas]

This is the most helpful and easiest explanation of this topic I've ever seen, kudos sir!!! Thanks for making this

[atlantisrose]

as a soon to be respiratory therapist this was an amazing explanation of the rationale and physiology of why proning is so beneficial. thank you for this great content.

[rbbruni]

Neonatologist here. I also tend to think that in babies prone positioning drops the abdominal organs, allows larger diaphragmatic excursion, and that increases (potentially )lung volumes

[snowgurl]

The best ARDS explanation and proning!! Covid 19 lungs are similar and some are put on a rotopron bed

[cornelbacauanu]

Essential info these days .Excellent explanation .Thank you .

[LifestyleLabUK]

Brilliant video: simple, concise, no-"water".
Thank you very much!

[jamesbuchanan]

I adopted the prone position when I had flu in November 2018. I lay on my front with my head over the edge of the mattress, because the mucus that was running into my chest was making me cough and it was becoming very painful. It took me several weeks to recover with the help of some anti-biotics. From a lay-mans point of view it seems a practical method to get the fluid out of the lungs to have your head at a lower level whilst lying on your front.

[ParaACP]

Great new blog Jonathan. Helped me understand the mechanisms involved much better than I previously did by just reading the literature alone. 👌👌👌

[lucylulusuperguru]

After seeing your presentation here...I'd happily work with you in a heartbeat...excellent grasp of the entire thing!

[dankan]

Hi Jonathan, thank you for the great explanation. I had a patient who was COVID +ve, and had a LT lower lobe collapse, supine CO2 was <8, however on proning this dramatically increased to >12. What would be the cause of this ?

When would you consider proning to be a contraindication ?

[aja]

Great video! I’m a new adv care practitioner in US and your videos are very helpful and informative!

[davidgarcia]

Thank you so much for your video from Madrid. Including the list of scientific papers.

[noemarcial]

Concidering corrent sanitary emergency and the fact that many people don't gets the ventilator witch are the downside of start prone the patient between 250 p/f and 150 p/f. Concidering that studies like proseva have show the best result close to 150 p/f ( but i dont find data about proning before) . today a small change that make a small improvement in the survival rate of covit 19 it will mean thousands of lifes

[ltshp]

Thanks! Could you please discuss these same factors as found in a patient who is primarily sitting or reclining? As might be found during typical hospital care or home illness. Would patients dealing with some form of respiratory stress/distress be well served by adopting a prone position?

[book]

I had a bad cold or flu last week and for 1.5 hours while I was trying to sleep on my back I was constantly coughing and I had a lot of gurgling and bubbling of fluid in my lungs. I've had that before so I was not alarmed but it was distressing to think I had the whole night ahead of me. I flipped over to sleep on my stomach and ALL of the bubbling and gurgling in my lungs went away and the coughing reduced to near zero. I was shocked at how dramatic the change was. I was basically able to sleep the rest of the night. I also slept on my stomach the 2nd night, though I had a little bit of coughing but I was eventually able to sleep most of the night. To sleep on my stomach I sleep with my head on the edge of the pillow so my face is angled slightly down and I prop up my shoulder with 3 folded towels and I also lift my hip on that same side with a crumpled up bedsheet. This reduces the amount of neck rotation needed to sleep on my stomach. Another trick is to add something to keep your head from sliding off the pillow. It's hard to describe but basically I use pillowcase with the T-shirt in the end of it that sticks out from under my pillow and that creates a stop (like a wedge) to prevent my head from sliding off the side of the pillow. I've worked out these tricks for sleeping on my stomach over the past 2 years because I find stomach sleeping helps me sleep a lot better. I'm 57 years old and turning my head to the side to sleep on my stomach is more difficult than a younger person, so these methods reduce the amount the head needs to be turned for stomach sleeping.

[markarca]

Noticed that in some news footages of some of the COVID-19 patients in a hospital ICU in Italy and they are placed in prone position. So the theory behind that is to allow phlegm and fluids to drain by gravity, and it is postural drainage in itself.

[rickyrn]

FreakING bad ass lecture from an ICU CCRN. Thank you Respect

[knheard]

Thank you for this information. My Brother In Law will be in a ROTO-BED in a few hours. 13 days with A(H1N1) and complications from the double pneumonia. This has to save him. Praying for his recovery.