[Postural technique in prone position: hemodynamic and respiratory parameters and complications]

Therapeutic strategies used in the treatment of adult respiratory distress syndrome (ARDS) recommend placing the patient in prone position as an effective method for optimizing ventilation-perfusion parameters. We evaluated the therapeutic effect of postural treatment in prone position with the following goals: Comparison of hemodynamic and respiratory parameters before and after placing the patient in prone position, while in prone position, and before and after postural treatment. Complications associated with turning and time in prone position. A prospective study was made of 30 turns in 15 patients admitted to the Polyvalent ICU between January 1999 and April 2000 for medical-surgical pathology, mean age 55.4 +/- 16.3 years, diagnosed as ARDS during their stay in the ICU, Lung Injury Score (Murray) > 2.5, and a medical prescription for prone position. Nurses were experienced in postural treatment in prone position in accordance with two protocols, the technique for placing the patient in prone position and nursing care for patients in prone position. Comparison of paired means of the hemodynamic variables MBP, HR and CVP did not disclose any statistically significant difference between the time before turning, while in prone position, and before and after postural treatment. Comparison of paired means of the respiratory variables PaO2/FiO2, Sat O2, tidal volume (TV), PCO2, pH, and PaO2/FiO2 ratio showed a significant increase after placing the patient in prone position, another increase after 2 hours in prone position, and before and after postural treatment. Sat O2 increased significantly 2 hours after turning, and remained raised while the patient was in prone position. TV increased significantly before and after postural treatment. The reduction in PCO2 occurred after 2 hours in prone position. Comparisons before and after postural treatment disclosed a clinically significant difference but no change in pH. Following the protocol for placing the patient in prone position, no complications were associated with the turning procedure (accidental loss of TOT, tracheostomy, SNG, urinary catheter, vascular catheters, chest tubes, and drainage tubes). While patients were in prone position, stage II and III UPP, palpebral and/or conjunctival edema, and intolerance of enteral feeding occurred, but our results do not indicate that these complications appeared solely as a result of prone position.