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.