Neonate with electrical impedance tomography electrodes

Proning or prone positioning is the placement of patients into a

prone position Prone position () is a body position in which the person lies flat with the chest down and the back up. In anatomical terms of location, the dorsal side is up, and the ventral side is down. The supine position is the 180° contrast. Etymolo ...

so that they are lying on their front. This is used in the treatment of patients in intensive care with

acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...

(ARDS). It has been especially tried and studied for patients on ventilators but, during the

COVID-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...

, it is being used for patients with

oxygen mask An oxygen mask provides a method to transfer breathing oxygen gas from a storage tank to the lungs. Oxygen masks may cover only the nose and mouth (oral nasal mask) or the entire face (full-face mask). They may be made of plastic, silicone, or r ...

s and

CPAP Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ap ...

as an alternative to

ventilation Ventilation may refer to: * Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation ** Mechanical ventilation, in medicine, using artificial methods to assist breathing *** Ventilator, a m ...

Intensive care

Prone positioning may be used for people suffering from

(ARDS) to improve their breathing. If the patient is undergoing

intensive care Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes pro ...

and sedated then this is a difficult procedure because lifting and turning the unconscious patient requires many staff or special equipment. If they are

intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blak ...

then care has to be taken to manage the tangle of associated lines and tubes. A 2011

meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting m ...

of 48 studies found that there were no negative effects on mortality for patients in intensive care but that a significant reduction in mortality was only found with those patients who were severely ill with ARDS. A 2012

systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...

(updated in 2022) of proning in infants with acute respiratory distress with mechanical ventilation found low certainty evidence that it was effective in improving oxygenation. No adverse effects were found but the risk of

sudden infant death syndrome Sudden infant death syndrome (SIDS) is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usuall ...

, which is greater in the prone position, necessitates continuous monitoring. A 2014

of 11 trials found that reduction of the

tidal volume Tidal volume (symbol VT or TV) is the volume of air moved into or out of the lungs during a normal breath. In a healthy, young human adult, tidal volume is approximately 500 ml per inspiration or 7 ml/kg of body mass. Mechanical vent ...

of ventilation, in combination with prone positioning, was effective, saving the life of about one additional patient in eleven. The Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE (LUNG-SAFE) conducted by the European Society of Intensive Care Medicine (ESICM) looked at the use of proning during the study period of 2014. At that time, proning was used for 7% of all ARDS patients and 14% of the most severe cases. The ESICM and

Surviving Sepsis Campaign The Surviving Sepsis Campaign (SSC) is a global initiative to bring together professional organizations in reducing mortality from sepsis. The purpose of the SSC is to create an international collaborative effort to improve the treatment of sepsis ...

published ''Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)'' in 2020. These recommended the use of proning: In the

, there is anecdotal evidence in areas such as New York, that prone or reclining posture can be used with oxygen supplied by a

mask A mask is an object normally worn on the face, typically for protection, disguise, performance, or entertainment and often they have been employed for rituals and rights. Masks have been used since antiquity for both ceremonial and pra ...

continuous positive airway pressure Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ...

(CPAP) to improve oxygenation and so avoid the need for intubation and ventilation. This especially effective with heavy, obese patients who suffer more on their back in a

supine position The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardium, pericardi ...

. In April 2020, the

Intensive Care Society The Intensive Care Society is the representative body in the United Kingdom for intensive care professionals and patients and the oldest society for critical care medicine in the world. The Society is dedicated to the delivery of the highest qualit ...

issued guidelines for the use of prone positioning with conscious COVID sufferers, recommending that it be tried for all suitable patients.

Mechanisms

There are several factors which have been suggested to explain the benefits of this position for ARDS patients. These include * better oxygenation due to the physical effects of the position, reducing the weight of the body on the

diaphragm Diaphragm may refer to: Anatomy * Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen * Pelvic diaphragm or pelvic floor, a pelvic structure * Urogenital diaphragm or triangular ligament, a pelvic structure Other * Diap ...

and lungs * a reduction in ventilator-associated lung injury (VILI) as the stress and strain on the lungs is reduced * improving the effectiveness of the

right ventricle A ventricle is one of two large chambers toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium, an adjacent chamber in the uppe ...

of the heart, which pumps blood through the lungs, and so reducing the incidence of fatal ''

cor pulmonale Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chroni ...

'' * better draining of lung fluids causing a reduction in

ventilator-associated pneumonia Ventilator-associated pneumonia (VAP) is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals. As such, VAP typically affects critically ill persons that are in an intensive care unit ( ...

Intensive care

Mechanisms

See also

References

Further reading