13 In patients with moderate to severe ARDS, proning significantly decreases mortality. The use of prone positioning as a treatment prevention of complication s related to the modality has been studied for more than 40 procedure itself. For patients with moderate/severe ARDS (PF ratio < 20kPa), prone positioning was recommended for at least 12 hours per day. Prone positioning may be used in the Intensive Care Unit in an attempt to improve survival in patients with severe hypoxia associated with acute respiratory distress syndrome (ARDS). The recommendation against the following intervention for the treatment of ARDS is strong: a. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall … Utilize COVID vent protocol (modified ARDS net protocol) Inhaled medications and use of vasoactives are not a contraindication for prone positioning. ARDS, prone positioning, mechanical ventila- Prone positioning (proning) has been used for many years to improve oxygenation in patients who require mechanical ventilator support for management of ARDS. ARDS is managed by treating the underlying cause of respiratory distress, through lung-protective mechanical ventilation strategies and ICU support including nutrition delivery and infection prevention. https://pulmccm.org/ards-review/prone-positioning-ards-ats-sccm The COVID-19 Treatment Guidelines Panel’s ... the Panel recommends considering a trial of awake prone positioning to improve oxygenation ... oxygen and should be monitored closely for worsening respiratory status because some patients may progress to acute respiratory distress syndrome (ARDS). In a significant proportion of these patients, prone positioning will improve pulmonary mechanics and ventilation- Rationale: The application of prone positioning for acute respiratory distress syndrome (ARDS) has evolved, with recent trials focusing on patients with more severe ARDS, and applying prone ventilation for more prolonged periods. 2,4 One treatment option for patients diagnosed with severe ARDS is placing the patient in a prone position. b. Prone positioning for more than 12 h/d in severe ARDS (moderate confidence in effect estimates) 2. ... with acute respiratory distress syndrome (ARDS) that will inform both key decisions in the care of individual ... these guidelines have relevance to a fraction of the total number Procedure (supine to prone) Ensure patient has no contraindications as listed above or as deemed by provider critical care have reported that patients with moderate to severe ARDS appear to have responded well to invasive ventilation in the prone position, leading to prone ventilation being recommended in international guidelines for the management of COVID-19. 5 (2) This corroborates well with the findings of the Routine use of high-frequency oscillatory ventilation in patients with moderate or severe ARDS (high confidence in effect estimates) 3. years, with recent studies showing an improve- Keywords: acute respiratory distress syndrome, ment in oxygenation and decreased mortality. In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain.

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