Low cost prone positioning of critically ill ARDS patients with the MPS (modular prone positioning system)

Introduction

Despite the many benefits of prone positioning in critically ill patients with respiratory failure and acute respiratory distress syndrome (ARDS) on the intensive care unit its technical aspects are not yet sufficiently defined. Different approaches exist with special beds for prone positioning, but these are difficult to handle, often not available and involve high costs. With this in mind, we developed an easy handling prone positioning system (MPS) that requires no special beds and run at low cost.

Methods

From 01.01.1996 to 31.07.97, 10 patients with severe atelectasis and ARDS were treated in the authors' institution by the MPS. The cause for prone positioning was in all cases bad gas exchange (PO₂/FiO₂ <200 mmHg) and severe atelectasis of conventional X-ray and CT scan. The positioning was performed over consecutive cycles of 12 h supported by physiotherapeutical measures like percussion and bronchioalveolar lavage. During the prone positioning the positive end-expiratory pressure (PEEP) was raised to 10–12 mmHg in the initial phase.

Results

The intermittent prone positioning was performed for a mean of 3 days (1–4). In all cases the PO₂/FiO₂ ratio rose to values over 300 mmHg after 24 h. According to the treating nurses and intensivists the handling of the MPS is easy and it provides better monitoring of the patient than previously used methods. The rental costs of the system, $600 for the prototype, were significantly lower than the costs for special prone positioning beds.

Conclusion

The MPS is a cost effective device yielding many benefits for prone positioning in critically ill patients with severe atelectasis and ARDS.