Prone positioning is a technique used in respiratory care that involves placing a patient face-down on their stomach. This method aims to provide mechanical support for breathing, particularly in individuals experiencing significant lung compromise. It optimizes lung function and facilitates recovery in various respiratory conditions, including pneumonia.
What Prone Positioning Involves
Prone positioning involves lying on one’s stomach, with the face directed downwards. This deliberate intervention supports respiratory efforts. It typically involves careful coordination to ensure patient comfort and safety during transition and while maintaining the position for extended periods.
The physical arrangement supports the chest and abdomen, allowing for free movement of the diaphragm and expansion of the lungs. Pillows or specialized support systems are often used to maintain alignment and prevent pressure points. This creates an environment where the lungs can function more effectively.
How Prone Positioning Aids Lung Recovery
Lying prone benefits lung function by altering pressure and fluid distribution within the chest. When a person lies on their back, the weight of the heart and abdominal contents can compress the dorsal (back) regions of the lungs, leading to collapse of small air sacs, known as alveoli. Moving to the prone position redistributes this pressure, allowing these previously compressed dorsal lung areas to reopen and participate in gas exchange.
This change improves oxygenation by making ventilation more uniform across the lungs. In the supine position, ventilation and blood flow may be mismatched, with more blood flowing to dependent areas that are less ventilated. Prone positioning promotes a better match between ventilation (airflow) and perfusion (blood flow) by recruiting collapsed alveoli and optimizing blood distribution to better-ventilated areas, leading to a more efficient transfer of oxygen into the bloodstream. It may also aid in the drainage of secretions from the posterior lung regions, which can accumulate in pneumonia, potentially reducing further complications.
When and How to Use Prone Positioning for Pneumonia
Prone positioning is primarily recommended for patients with severe pneumonia, especially those who develop acute respiratory distress syndrome (ARDS), a complication where fluid builds up in the lungs. It is often considered when oxygen levels remain low despite other oxygen support measures. For patients on mechanical ventilation, prone positioning is a standard practice for moderate to severe ARDS when the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) is typically below 150 mmHg.
Implementing prone positioning in a hospital setting involves a team of healthcare providers who carefully turn the patient to prevent injury or dislodgement of medical lines. The position is maintained for prolonged periods, often 12 to 18 hours per day, followed by periods in the supine position for nursing care and to alleviate pressure. For mild cases of pneumonia where patients are awake and breathing spontaneously, “awake prone positioning” might be considered at home with professional guidance, though its impact on avoiding intubation or mortality is still being studied.
Safety Considerations
While prone positioning offers benefits for lung recovery, it is a medical intervention requiring careful consideration of potential risks and contraindications. A primary concern is pressure injuries on areas like the face, chest, and knees, which require proper padding and frequent repositioning to prevent. Airway safety is important, especially for intubated patients, as there is a risk of endotracheal tube obstruction or accidental dislodgement during turning.
Certain medical conditions may make prone positioning inadvisable. These include unstable spinal injuries, pelvic or long bone fractures, and conditions causing increased intracranial pressure. Patients who are hemodynamically unstable or experiencing malignant arrhythmias may require extreme caution, although defibrillation can still be performed while prone. Monitoring for adverse effects such as breathing difficulties, changes in vital signs, or nerve injuries like brachial plexus or ulnar nerve injury is necessary throughout the process.