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Related Concept Videos

Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

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Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
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Anatomical Positions01:11

Anatomical Positions

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In anatomy, several standard anatomical positions are used as references for describing the position and orientation of different body parts. These positions help provide a common frame of reference when discussing anatomical structures. The anatomical position is the standard reference point for describing the body's position and orientation. In this position:
The body is upright, facing forward, and standing erect.
The feet are parallel and flat on the floor.
The arms are hanging by the...
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Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

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Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
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Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques01:30

Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques

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Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
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Endotracheal Intubation II: Nursing Management01:17

Endotracheal Intubation II: Nursing Management

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Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
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Updated: Jul 24, 2025

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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Extended prone positioning for intubated ARDS: a review.

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Extending prone positioning beyond 24 hours for COVID-19 patients may reduce mortality by improving gas exchange and decreasing ventilator-induced lung injury. However, potential risks like pressure injuries require further investigation.

Keywords:
Acute respiratory distress syndromeExtended prone positioningMechanical ventilationProlonged prone positioningProne positioning

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Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Respiratory Therapy

Background:

  • The COVID-19 pandemic saw widespread use of prone positioning, often extended beyond 24 hours.
  • Centers independently adopted extended prone positioning based on clinical improvement or fixed durations.
  • A recent study suggested clinically driven extension of prone positioning may reduce mortality.

Purpose of the Study:

  • To review the benefits and risks of extending prone positioning beyond 24 hours in critically ill patients.
  • To discuss patient-level and organizational advantages of prolonged prone positioning.
  • To highlight the need for prospective evaluation of extended prone positioning protocols.

Main Methods:

  • Review of existing literature and center practices regarding extended prone positioning during the COVID-19 pandemic.
  • Analysis of patient-level physiological benefits, including gas-tissue ratio and overdistention.
  • Evaluation of organizational benefits, such as reduced healthcare worker workload and fewer accidental device dislodgements.

Main Results:

  • Extended prone positioning can maintain homogenous gas-tissue distribution, delaying supine-position-induced overdistention.
  • Organizational benefits include reduced staff workload and decreased incidence of catheter/tube removal.
  • The primary risk identified is an increased incidence of pressure injuries, though retrospective data are reassuring.

Conclusions:

  • Extending prone positioning beyond 24 hours offers potential patient and organizational benefits in critical care settings.
  • Further prospective studies are necessary to confirm the safety and efficacy of prolonged prone positioning and to mitigate risks like pressure injuries.