Proning is the process of placing a mechanically ventilated patient in the prone position (lying on their stomach)

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Its primary indication is for severe ARDS with life-threatening, refractory hypoxaemia

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Contraindications:

• Untrained staff

• Raised intracranial or intra-abdominal pressures

• Abdominal or chest wounds

• C-spine precautions

• Haemodynamic instability

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Benefits:

• Improved V/Q matching

• Improved lung mechanics

  • More uniform compliance​

  • Reduced regional alveolar over-distension and atelectasis

  • Less ventilator-associated lung injury

• Reduced lung compression from heart and abdominal contents

  • Further improves lung compliance​

• Increased functional residual capacity (by up to 300 - 400ml)

• Improved drainage of airway secretions

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Limitations:

• Increased nursing workload

• Reduced airway control

• Reduced line/drain safety

• Impaired access for line placement

• Reduced pressure-area care

  • More difficult for side-lying​

  • New sensitive pressure-prone areas

    • eg. eyes, mouth, nose, ulnar nerves, breasts, pelvis, genitals​

• Facial oedema

• Elevated intracranial and intra-abdominal pressures

• Poor NG feed tolerance