Advertisement

Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

Published:March 12, 2018DOI:https://doi.org/10.1016/j.amj.2018.02.003

      Highlights

      • Critical care transport of prone acute respiratory distress syndrome patients is a feasible and cost-effective intervention that will help prevent treatment delays and interruptions.
      • A nonphysician critical care transport team (registered nurse and paramedic) can initiate prone positioning before transport.

      Abstract

      We report the case of a non-physician based critical care transport team (registered nurse and paramedic) that successfully initiated prone positioning of a severe acute respiratory distress patient prior to transport to an extracorporeal membrane oxygenation capable teaching hospital.
      With the increasing use of advanced treatments such as extracorporeal membrane oxygenation, prone positioning, and continuous renal replacement therapy for severe acute respiratory distress syndrome (ARDS), the necessity to transport these patients to specialized hospitals will correspondingly increase. Emergency Health Services Life Flight, the primary critical care transport program in Eastern Canada, developed a prone position protocol to meet this clinical need. Since the implementation of the protocol, we have successfully initiated prone positioning of 2 patients with ARDS before transport to an extracorporeal membrane oxygenation– and continuous renal replacement therapy–capable teaching hospital. This represents the first report of a nonphysician (registered nurse and paramedic) critical care team initiating prone positioning before transport. Consent for publication was only obtained in the second case, which we present here.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ranieri V.M.
        • Rubenfeld G.D.
        • et al.
        • ARDS Definition Task Force
        Acute respiratory distress syndrome: the Berlin definition.
        JAMA. 2012; 307: 2526-2533
        • Slutsky A.S.
        • Ranieri V.M.
        Ventilator-induced lung injury.
        N Engl J Med. 2014; 370: 980
        • Cressoni M.
        • Chiumello D.
        • Algieri I.
        • et al.
        Opening pressures and atelectrauma in acute respiratory distress syndrome.
        Intensive Care Med. 2017; 43: 603-611
        • Gattinoni L.
        • Tonetti T.
        • Cressoni M.
        • et al.
        Ventilator-related causes of lung injury: the mechanical power.
        Intensive Care Med. 2016; 42: 1567-1575
        • Protti A.
        • Maraffi T.
        • Milesi M.
        • et al.
        Role of strain rate in the pathogenesis of ventilator-induced lung edema.
        Crit Care Med. 2016; 44: e838-e845
        • Gattinoni L.
        • Tognoni G.
        • Pesenti A.
        • et al.
        Effect of prone positioning on the survival of patients with acute respiratory failure.
        N Engl J Med. 2001; 345: 568-573
        • Guerin C.
        • Gaillard S.
        • Lemasson S.
        • et al.
        Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial.
        JAMA. 2004; 292: 2379-2387
        • Mancebo J.
        • Fernandez R.
        • Blanch L.
        • et al.
        A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 2006; 173: 1233-1239
        • Fernandez R.
        • Trenchs X.
        • Klamburg J.
        • et al.
        Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial.
        Intensive Care Med. 2008; 34: 1487-1491
        • Alsaghir A.H.
        • Martin C.M.
        Effect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis.
        Crit Care Med. 2008; 36: 603-609
        • Taccone P.
        • Pesenti A.
        • Latini R.
        • et al.
        Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial.
        JAMA. 2009; 302: 1977-1984
        • Gattinoni L.
        • Carlesso E.
        • Taccone P.
        • Polli F.
        • Guerin C.
        • Mancebo J.
        Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis.
        Minerva Anestesiol. 2010; 76: 448-454
        • Sud S.
        • Friedrich J.O.
        • Adhikari N.K.
        • et al.
        Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.
        CMAJ. 2014; 186: E381-E390
        • Abroug F.
        • Ouanes-Besbes L.
        • Dachraoui F.
        • Ouanes I.
        • Brochard L.
        An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury.
        Crit Care. 2011; 15: R6
        • Guerin C.
        • Reignier J.
        • Richard J.C.
        • et al.
        Prone positioning in severe acute respiratory distress syndrome.
        N Engl J Med. 2013; 368: 2159-2168
        • Johnson N.J.
        • Luks A.M.
        • Glenny R.W.
        Gas exchange in the prone posture.
        Respir Care. 2017; 62: 1097-1110
        • Mutoh T.
        • Guest R.J.
        • Lamm W.J.
        • Albert R.K.
        Prone position alters the effect of volume overload on regional pleural pressures and improves hypoxemia in pigs in vivo.
        Am Rev Respir Dis. 1992; 146: 300-306
        • Chatte G.
        • Sab J.M.
        • Dubois J.M.
        • Sirodot M.
        • Gaussorgues P.
        • Robert D.
        Prone position in mechanically ventilated patients with severe acute respiratory failure.
        Am J Respir Crit Care Med. 1997; 155: 473-478
        • Koulouras V.
        • Papathanakos G.
        • Papathanasiou A.
        • Nakos G.
        Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review.
        World J Crit Care Med. 2016; 5: 121-136
        • Miranda C.C.
        • Newton M.C.
        Successful defibrillation in the prone position.
        Br J Anaesth. 2001; 87: 937-938
        • Uusaro A.
        • Parviainen I.
        • Takala J.
        • Ruokonen E.
        Safe long-distance interhospital ground transfer of critically ill patients with acute severe unstable respiratory and circulatory failure.
        Intensive Care Med. 2002; 28: 1122-1125
        • Flabouris A.
        • Schoettker P.
        • Garner A.
        ARDS with severe hypoxia–aeromedical transportation during prone ventilation.
        Anaesth Intensive Care. 2003; 31: 675-678
        • DellaVolpe J.D.
        • Lovett J.
        • Martin-Gill C.
        • Guyette F.X.
        Transport of mechanically ventilated patients in the prone position.
        Prehosp Emerg Care. 2016; 20: 643-647