Why are Patients on their Stomachs in the ICU?

Intubating and placing a patient on a ventilator is one of the most distressing procedures in the practice of medicine.
 

This bridge support therapy buys time, but it could potentially cause harm if the team isn’t coordinated and trained properly.

Effectively oxygenating the body without causing further damage is a challenging task. The clinical team has become very aware of the pressure curve by which oxygen is delivered. In certain patients, high volume and high pressure — quickly delivered with high-concentration oxygenated air — causes shear forces that create further damage. Thus, we have learned to lower the volume, make the delivery cycle longer, increase the inspiration to expiration ratio, decrease shear force, and to prone.

Proning a patient means that we flip them on their stomach while on the ventilator to recruit the lungs in the back and bases of the lungs. When a patient is lying flat, these are the areas that accumulate fluid and collapse. Proning is not easy and can be potentially dangerous if not done correctly and with a coordinated team. Proning the patient recruits more alveoli, thus giving the ventilator a larger “lung” to deliver a similar volume. This decreases the pressure curve and the sheer force, thereby decreasing the potential for injury. It’s another example of “flattening the curve.”

Our Executive Summary entitled “Ventilators: Strategic Sourcing During the Coronavirus Pandemic” provides a link to the guideline statements from the World Health Organization (WHO) and Surviving Sepsis COVID-19 subcommittee. It’s not just about getting ventilators: it’s important to have a coordinated and trained team of personnel who know how to use them.

Author:

Mark S. Kestner, MD, MBA

Chief Medical Officer

Mark is a surgeon with deep leadership experience in military, university, integrated delivery, and especially community-based healthcare systems.

 

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