(250) Only Five Minutes to Place Prone and Just Six Pairs of Hands to Save a Life!

Introduction: Proning is a therapeutic intervention utilized to improve oxygenation and decrease ventilator-induced lung injury in patients with severe respiratory distress. This case report describes a patient with severe COPD exacerbation who was effectively managed with proning and compares three studies investigating the efficacy of prone positioning in patients with ARDS and COPD.

Description: A 56-year-old man with severe COPD was admitted to the Medical Intensive Care Unit with a COPD exacerbation. Upon admission, he was somnolent, and arterial blood gas showed pH of 7.32, CO2 of 73, and SpO2 of 39. CT chest revealed dense lower lobe consolidation/atelectasis and pulmonary vascular congestion. He required intubation due to worsening shortness of breath and mental status. Despite being administered 100% FiO2 and a trial of IV Lasix, he remained hypoxic with a PaO2/FiO2 (P/F) ratio of 67. Proning was initiated, and after 12 hours of prone positioning, the P/F ratio improved to 211. He remained proned for a total of 16 hours/day, with 8 hours in the supine position for alveolar recruitment. Neuromuscular blockade was continued. Over four days of proning and re- proning, the P/F ratio significantly improved from 67 to 268, and he was successfully extubated and transferred to rehabilitation. The proning team consisted of six members and required five minutes to prone him.

Discussion: Our study examined three trials on proning, team size, and duration. Guérin et al. (2013) studied 466 severe ARDS patients, prone for 17 hrs/session, with a team of 3. Mentzelopoulos et al. (2003) studied 10 COPD patients, prone for 65-75 mins/posture, with a team of 6. Our patient, like Guérin et al., needed 6 attendants for proning. Reignier et al. (2005) focused on 11 COPD patients with alternating 6-hr prone-supine positions but didn't mention the team size. Despite variations, all studies improved oxygenation, offering a cost-effective alternative to invasive interventions. Optimizing proning practices based on patient acuity and tailoring team size may enhance outcomes. We hope our findings will guide intensivists in effectively incorporating proning and elevating respiratory support strategies.