Proning the ARDS patient- why do we do it? 

This was posted almost exactly two years ago. Look at all of us boning up on our pulmonary physiology during the pandemic. Crazy times. Thank you Jonathon! Be well everyone!

The best articulated and explained lecture on Prone ventilation I’ve heard! Thank you!

This is the most helpful and easiest explanation of this topic I've ever seen, kudos sir!!! Thanks for making this

as a soon to be respiratory therapist this was an amazing explanation of the rationale and physiology of why proning is so beneficial. thank you for this great content.

Neonatologist here. I also tend to think that in babies prone positioning drops the abdominal organs, allows larger diaphragmatic excursion, and that increases (potentially )lung volumes

The best ARDS explanation and proning!! Covid 19 lungs are similar and some are put on a rotopron bed

Essential info these days .Excellent explanation .Thank you .

Brilliant video: simple, concise, no-"water". Thank you very much!

I adopted the prone position when I had flu in November 2018. I lay on my front with my head over the edge of the mattress, because the mucus that was running into my chest was making me cough and it was becoming very painful. It took me several weeks to recover with the help of some anti-biotics. From a lay-mans point of view it seems a practical method to get the fluid out of the lungs to have your head at a lower level whilst lying on your front.

Great new blog Jonathan. Helped me understand the mechanisms involved much better than I previously did by just reading the literature alone. 👌👌👌

After seeing your presentation here...I'd happily work with you in a heartbeat...excellent grasp of the entire thing!

Hi Jonathan, thank you for the great explanation. I had a patient who was COVID +ve, and had a LT lower lobe collapse, supine CO2 was 12. What would be the cause of this ? When would you consider proning to be a contraindication ?

Concidering corrent sanitary emergency and the fact that many people don't gets the ventilator witch are the downside of start prone the patient between 250 p/f and 150 p/f. Concidering that studies like proseva have show the best result close to 150 p/f ( but i dont find data about proning before) . today a small change that make a small improvement in the survival rate of covit 19 it will mean thousands of lifes

Thank you so much for your video from Madrid. Including the list of scientific papers.

Thank you for this information. My Brother In Law will be in a ROTO-BED in a few hours. 13 days with A(H1N1) and complications from the double pneumonia. This has to save him. Praying for his recovery.

Great video! I’m a new adv care practitioner in US and your videos are very helpful and informative!

FreakING bad ass lecture from an ICU CCRN. Thank you doctor!!!!!!!!!!!!!! Respect respiratory!!!!!!

3:20 was the most helpful part.

Thanks! Could you please discuss these same factors as found in a patient who is primarily sitting or reclining? As might be found during typical hospital care or home illness. Would patients dealing with some form of respiratory stress/distress be well served by adopting a prone position?

I had a bad cold or flu last week and for 1.5 hours while I was trying to sleep on my back I was constantly coughing and I had a lot of gurgling and bubbling of fluid in my lungs. I've had that before so I was not alarmed but it was distressing to think I had the whole night ahead of me. I flipped over to sleep on my stomach and ALL of the bubbling and gurgling in my lungs went away and the coughing reduced to near zero. I was shocked at how dramatic the change was. I was basically able to sleep the rest of the night. I also slept on my stomach the 2nd night, though I had a little bit of coughing but I was eventually able to sleep most of the night. To sleep on my stomach I sleep with my head on the edge of the pillow so my face is angled slightly down and I prop up my shoulder with 3 folded towels and I also lift my hip on that same side with a crumpled up bedsheet. This reduces the amount of neck rotation needed to sleep on my stomach. Another trick is to add something to keep your head from sliding off the pillow. It's hard to describe but basically I use pillowcase with the T-shirt in the end of it that sticks out from under my pillow and that creates a stop (like a wedge) to prevent my head from sliding off the side of the pillow. I've worked out these tricks for sleeping on my stomach over the past 2 years because I find stomach sleeping helps me sleep a lot better. I'm 57 years old and turning my head to the side to sleep on my stomach is more difficult than a younger person, so these methods reduce the amount the head needs to be turned for stomach sleeping.

Well explained!Thank you for sharing i understand more the pathophysilogy of prone positioning and including the list of literature. I need it for my revisions.

Noticed that in some news footages of some of the COVID-19 patients in a hospital ICU in Italy and they are placed in prone position. So the theory behind that is to allow phlegm and fluids to drain by gravity, and it is postural drainage in itself.

RE CoVid patients: Does forward or backward tilting of the patient in the prone position help with fluid in the lungs control; and, will diuretics help remove some of the lung fluids? Non-medical, non-engineer inventor. Have read Richtel's : "An Elegant Defense" 5 times though. Based on that, Dr. Fauci has a known plan for developing a therapeutic, I believe.

Thank you very much! From Sri Lanka🇱🇰

Question. If you incline the patient so their head is slightly lower than their feet while they are prone, will there be a better draining from the lungs? I seem to remember reading something about doctors doing this during the SARS outbreak in 2002, but I can't find any info about this. Would this be an option for serious cases for the current COVID19 outbreak?

Excellent explanation, thank you!

Great information. Thank you .

You seem to know a bit about lungs. For people with mild dyspnea. Are there movements to help massaging alveolis and improve oxygenation ? I move my shoulders to modify my chest shape and it feels better (now how much is placebo..? hence my question).

very good video, sir, thank you!

It's really hard to follow without ample illustrations, and explanation of technical terms, at least to me as a layperson in these matters...

I wonder if you'd address methods of lying prone. An obese person has difficulty lying prone. What is your practice in that case?

This is fascinating and very helpful!

Thanks for the excellent explanation and presentation!

Just found out my Aunt was placed in one of these to try and treat her for Covid-19. The medications they tried didn't work so now they're trying this.

Anluer said we sit jp when chest infevtions and i asked about whh ventilators were set so low and ...nio answer .later i saw tbwt increase of acudosis yet optimum penstrayion for crona is pH 5:5 yet it t flourishes at lower pHs too because a idif solutions dont kill it off sp is sitting pstiejtz up with chest infectionz only wben no ARDS ?sitti g patie ts up in hrart failure vhest infectinz what hhdb do.

I'm afraid there is a mistake. In the supine position the dorsal alveolis, at reast, are smaller and less expanded then the vental ones, but this means that during the inspiration the dorsal alveolis (with the same pressure variation) have a greater expantion in comparison with the ventral ones. Therefore the dorsal region is better ventilated then the ventral region And I still don't understand why in ARDS the the prone position improve the V/Q ratio

How smart do you feel right now having posted this 2 years ago?

Can you review the “Odom Ultra flu A&B testing ?? Instructions on collecting samples. Also instruction on collecting strep testing ? I just subscribed after your lecture on supine/prone ARDS, brilliant!!

Thanks ❤️

Hello Jonathan. Do you Know a consensus? Or which Is you opinion about when to stop prononing? 3,4,5..8,9 data?

Thanks for the explanation. But I have a question. What if an ARDS patient had a cardiac arrest during prone ventilation, will you attempt to perform CPR while the patient is in the prone position?

Thanks, nicely explained..👍🏼

Hi, can I have a request? For the sake of emergency response on Pandemic situation and the upcoming 2020 CPR Guidelines, can you upload RU-vid videos on how to manage a Prone Ventilated Asystolic (cardiac arrest) patient using Prone CPR simulation? Majority of CPR mannequin simulation for Asystolic CoVid-19 patients on RU-vid are Really Disappointing, in which they NEVER did a CPR simulation on a patient undergoing prone ventilation since hospital staffs around the world are trained to do PRONING.

This helped so much! thank you

My opinion is that it will be much better to lower the head end of the patient's bed by about 10 degrees so that the lungs can drain with the help of gravity naturally in the supine position, in much the same way as one would do with a recovering drowning person. A mixture of a few % alcohol in the patient's inhaled gas would help to break up sticky mucus, ease stress on alveoli and reduce infection. All this work in this vid cited as good, credible med practice is fine, but it makes patients look as if they are on a spit roast. Still, its better than a course of leeches. I would like to add here that as a chronic sufferer of bronchitis, asthma and emphysema for 50 years, I found early that the above worked well to ease my symptoms and quickly restore normal breathing from chronic struggle. For my self-treatment, I used to heat up vodka in a pan and inhale the vapour with a towel over my head for a few minutes, then lie with my head over the end of the bed for a while to drain my lungs, and repeat until I felt somewhat better. It worked and still does, or I would not have done the same all these years without the need for medication. That is what happens when you live in traffic pollution centre London. Matey.

Thank you, sir.🤠😊👍🏽🇺🇸

Will it help a corona patient not yet in resp. Distress? Patient is feverish x 30 days. No sob. On abx but not improving. Diabetic x 30 years uncontrolled.

Did you take into account the weight of the spine and back muscles? Do you need higher airway pressures? What about the personnel needed to keep turning the patient?

Thank you!

Can we use this in covid problem

I’m here because I noted the Italians had their ITU patients prone during the COVID19

Would it be more helpful to have the patient on their belly with their hips being higher than their shoulders?

Ventilator Induced Lung Injury...Okay people need to know this!!

excellent

Great explanation. Anaes doc.

Hello Jonathan, I have COPD and am having surgery in the prone position. How safe is intubation in this position?

No wonder why I sleep quickly on prone position!

Great graphic education, thank you but please what is a 'slinky'????

Maybe I missed it, but why not laying on the l/r- side? That would reduces the stress on the heart. Another thing is, when laying on the back to put both hands behind the head. That opens up the lungs.

superb👍👍👍👍

Bravo

If you are sick, by all means sleep on your stomach.

It's the SUJUD position ..

Wow, why don't I think most doctors in America don't know or practice this, especially now...

wht if they start standing patients up

This is why bats hang upside down in moist and cold caves. This position protects the lungs more easily. Gravity helps the secretions.

Anyone else think their screen was scratched, below the cabinets? 😅

Anyone else noticed Windows Vista in the background?

You must have said great things. But please realize that these days patients or their families also Google around to understand the situation and options. So pls simplify for this kind of desperate audience too

Actually it is the position of prostration we do in our 5-time daily prayers in Islam. God knows what is the best for us.

Muslims do this 5 times a day on daily basis threw prayer (bowing their forhead down)

👍👌👍👌👍👌👍👌👍

So proning is upside down planking. I see.

30 years working with ventilator patients. Never in prone position. Cannot see any advantage or practicality in the actual physical care. G.

Why don't they hang them up like bats in daytime?

Concidering corrent sanitary emergency and the fact that many people don't gets the ventilator witch are the downside of start prone the patient between 250 p/f and 150 p/f. Concidering that studies like proseva have show the best result close to 150 p/f ( but i dont find data about proning before) . today a small change that make a small improvement in the survival rate of covit 19 it will mean thousands of lifes