Prospective study to evaluate the kind of prone position concerning nursing, pulmonary outcome and material and personnel resources

Introduction

Acute Respiratory Distress Syndrome (ARDS) is one of the most common, potentially lethal disease processes encountered in critical care with extremely high mortality of about 60%. Researchers have found that a significant improvement in gas exchange often occurs when ARDS patients are turned from the supine to the prone position. But there are a lot of difficulties in nursing these patients in dependence of the kind of kinetic therapy. So the major goal is, to find out the best kind of kinetic therapy. The available study is designed by physicians and nurses. Besides the question of patients benefit concerning the gas exchange the handling, the acceptance of the nurses and economical consequences are proofed.

Methods and materials

Patients with ARDS, or those patients identified as requiring to be nursed in the prone position with a Horowitz-Quotient (PaO₂/FiO₂) < 250 were treated by different kinds of kinetic therapy in order to compare the efficiency concerning clinical outcome, personnel and material resources and the incidence of complications. Patient were turned into face down prone position, in near side prone position or they were treated in a Rotation bed. Gas analysis defined the clinical effect of the position on gas exchange. Also changes in skin integrity, skin status and clinical outcome of prone positioning were documented. Additionally number of nurses/physicians being involved in positioning the patient and the duration of time was documented.

Results

Ten patients were positioned in near side prone position (NSPP). Eight patients were positioned in 180°-position and 10 patients were treated in rotation bed. In handling, nursing and observing the NSPP is the preferred kind of kinetic therapy. The pulmonary outcome is comparable to the other forms of kinetic therapy but less need of personnel and material resources and the very small risk of complication (skin damages, oedema formation, lost of catheter or tube) are advantages of the NSPP. So at every point of time position changing can occur. Also the patients treated in rotation bed shows a similar clinical outcome concerning the gas exchange but the need of material resources is disproportionately high and the availability is to be estimated very low.