Prone positioning protocol
Guided by the collective agreement among medical professionals and nursing staff within our institution, we have formulated comprehensive protocols for postoperative care, implemented a dedicated interdisciplinary team, and implemented standardized training procedures to ensure the uniformity of PP treatment for patients.
The indications for PP are as follows: ① When ARDS recalcitrant hypoxemia cannot be corrected by conventional mechanical ventilation; ② It is strongly recommended for severe ARDS when the oxygenation index is ≤100mmHg; ③ It is recommended for consideration when the oxygenation index is <150mmHg with PEEP ≥5cmH2O and FiO2 ≥0.6. (After the patient is admitted to the ICU, the treatment team will assess the patient’s disease condition and preferences, and initiate PP therapy in accordance with the September 2022 issue of the Shanghai Expert Recommendations on PP Therapy for Patients with COVID-19.)
The contraindications for PP include: ① Severe hemodynamic instability in critically ill patients; ② Craniocerebral trauma accompanied by moderate or severe intracranial hypertension; ③ Acute bleeding disorders; ④ Severe multiple injuries resulting in significant damage to the cervical vertebrae, spine, pelvis, chest wall, and abdomen; ⑤ Severe facial trauma or recent facial surgery; ⑥ Recent orthopedic and abdominal surgeries.⑦ Patients with cardiac pacemakers or ventricular arrhythmias implanted within a span of 48 hours; ⑧ Patients with deep vein thrombosis occurring within a period of 48 hours; ⑨ Pregnancy.
The termination criteria for PP include: ① The occurrence of severe complications and potential risks during the operation; ② The decision to discontinue treatment made by the physician based on the progression of the disease; ③ Voluntary abandonment of treatment by patients and their families.