Prone Positioning for Patients with ARDS – Care Example

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"Prone Positioning for Patients with ARDS" is a great example of a paper on care. One practice that is observed in the clinical setting that is considered evidence-based is prone positioning for patients with acute respiratory distress syndrome (ARDS). According to different research studies as published in several nursing and medical journals, the use of prone positioning significantly assists patients reportedly diagnosed with ARDS through the benefits of increased oxygenation, among others (Messerole, Peine, Wittkopp, Marini, & Albert, 2002; Taccone, et al. , 2009; Hudack, 2012). The current discourse hereby presents a brief summary of this evidence-based practice through the support from three nursing source references.                   The article was written by Hudack (2012) initially presented a brief overview of ARDS and stipulated that complexity of the syndrome by asserting that its comprehensive etiology has allegedly been only partially understood.

On a more accurate medical level, Hudack (2012) provided the definition of ARDS through that which was postulated by the American-European Consensus Conference, to wit: “ bilateral infiltrates on chest X-ray, consistent with pulmonary edema;   no clinical evidence of left atrial hypertension with a pulmonary artery occlusion pressure of 18 mm Hg or less; PaO2/FiO2 ratio of 200 mm Hg or less regardless of positive end-expiratory pressure (PEEP) level” (p.

22).   Further, prone positioning was expounded in terms of specifically identifying if the position and intervention positively improved the condition of patients identified to have ARDS. Aside from allegedly increasing oxygenation level, Hudack (2012) was noted to report other benefits as evidenced from other studies: increased PaO2 values; and “ improvement in PaO2/FiO2 ratios, reduced pulmonary-related mortality, fewer ventilator days, and shorter hospital length of stay than supine kinetic therapy” (Davis, LeMaster, Moore, & al., 2007, cited in Hudack, 2012, p.

22).                   The studies however indicated that there is no significant improvement in mortality or survival rates for patients with ARDS from among the 342 patients that were subject to the study conducted by Taccone, et al. (2009). As such, it was emphasized that future research on the subject could be further explored.                   Despite reported benefits, the articles reviewed indicated that there could be apparent apprehensions of health care practitioners, particularly nurses, to apply this practice due to “ little experience with the pruning process, or with caring for or monitoring patients when they are prone” (Messerole, Peine, Wittkopp, Marini, & Albert, 2002, p.

1362). As emphasized by Hudack (2012), ICU nurses should have the proper skills, training, and expertise in assessing the need to apply this position to patients, and the ability to communicate its potential benefits to the patients’ family members. Some have noted contraindications for prone positioning (Hudack, 2012); while other studies stated that “ no studies have objectively identified any absolute contraindications to prone positioning, (thus) suggest that serious burns or open wounds on the face or ventral body surface, spinal instability (as might be seen in patients with rheumatoid arthritis or trauma), pelvic fractures, or life-threatening cardiac arrhythmias or hypotension should preclude prone positioning” (Messerole, Peine, Wittkopp, Marini, & Albert, 2002, p.

1359). Overall, the effective application of prone positioning depends on the training and skills set of ICU nurses, as well as the factors and assessment of patients who would most benefit from it.

References

Davis, J., LeMaster, D., Moore, E., & al., e. (2007). Prone ventilation intrauma or surgical patients with acute lung injury and ARDS: is it beneficial? J Trauma, Vol. 62, No. 5, 1201-1206.

Hudack, M. (2012). Prone positioning for patients with ARDS. Nursing Critical Care, Vol. 7, Issue 2, 20–24.

Messerole, E., Peine, P., Wittkopp, S., Marini, J., & Albert, R. (2002). The Pragmatics of Prone Positioning. American Journal of Respiratory and Critical Care Medicine, Vol. 165, No. 10, 1359-1363.

Taccone, P., Pesenti, A., Latini, R., Polli, F., Vagginelli, F., Mietto, C., . . . Group, P.-S. I. (2009). Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA, Vol. 302, No. 18, 1977-84.

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