TY  - CHAP
M1  - Book, Section
TI  - Prone Positioning in ARDS
A1  - Douglas, Ivor S.
A1  - Albert, Richard K.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
A2  - Douglas, Ivor S.
Y1  - 2023
N1  - 
T2  - Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
AB  - KEY  POINTSProne  positioning,  when  started  early  in  the  management  of  severe  acute  respiratory  distress  syndrome  (ARDS),  is  an  effective  modality  to  improve  oxygenation  and  survival  and  warrants  widespread  adoption.Prone  position  ventilation  (PPV)  is  readily  implemented,  including  in  under-resourced  care  environments,  without  specialized  equipment  and  with  a  moderate  amount  of  team-based  expertise  and  experience,  including  the  care  of  patients  with  COVID-19-related  ARDS.PPV  reduces  ventilator-induced  lung  injury  by  reducing  the  strain  associated  with  both  volutrauma  and  atelectrauma.  The  observed  improvement  in  survival  appears  to  be  mechanistically  dissociated  from  other  salutary  effects,  including  reducing  intrapulmonary  shunting  and  improved  oxygenation.PPV  is  safe  and  broadly  effective  when  initiated  for  the  management  of  ARDS  in  patients  with  a  P/F  ratio  <150  as  a  result  of  medical  and  surgical  causes  of  disease.  Morbidly  obese  and  pregnant  patients  appear  to  derive  similar  if  not  greater  degrees  of  improvement.Major  complications  are  infrequent  even  when  PPV  is  continued  in  an  uninterrupted  fashion  for  several  days  and  include  skin  breakdown  on  the  ventral  body  surface,  facial,  conjunctival,  and  upper  airway  edema  at  rates  higher  than  ARDS  patients  managed  in  the  supine  position.  Very  rarely,  brachial  plexus  injuries,  other  mononeuritides,  and  retinal  ischemia  with  blindness  may  occur.Patient-directed  self-proning  appears  to  be  beneficial  for  improving  oxygenation  in  nonintubated  patients  with  hypoxemic  respiratory  failure  but  the  impact  on  progression  to  need  for  intubation  and  mechanical  ventilation  and  associated  mortality  is  unknown.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/10/09
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1201803483
ER  -