Transport of Mechanically Ventilated Patients in the Prone Position

We present seven cases of patients with severe respiratory failure refractory to conventional ventilation who were safely transported in the prone position.

We describe all cases of patients transported by a regional critical care network in the prone position from January 2010-June 2015. All patients were mechanically ventilated for respiratory failure and transported by specialized nonphysician critical care teams. Utilizing direct medical oversight and real-time technical support from the clinical department, each patient underwent a thorough bedside evaluation, transport ventilator trial, and transfer to a transport stretcher either with the endotracheal tube secured by an anesthesia pillow or overhanging the stretcher.

Seven patients with acute respiratory distress syndrome were transported in the prone position. Four were female (57%), with a median weight of 78 kg (range 58-131) and median age of 53 years (range 37-78). Initial vital signs demonstrated a median oxygen saturation of 94% (range 90-97%) supported with a FiO2 of 100% for all patients with a median positive end-expiratory pressure (PEEP) of 16 (range 14-20). Seven patients were transported, six by helicopter and one transported by ground ambulance. The median transport time was 36 minutes (IQR 19, 51). There were no deaths or major incidents (tube dislodgement or line displacement) during patient transport.

The transport of mechanically ventilated patients with respiratory failure in the prone position is feasible and safe, with minimal complications identified in this case series.