ALISO VIEJO, Calif. – Jan. 15, 2019 – When research and new clinical guidelines strongly recommend that critically ill patients with severe acute respiratory distress syndrome (ARDS) be face-down for most of the day, the change requires a team approach to integrate the logistically challenging, multifaceted repositioning procedure into clinical practice.
ARDS is estimated to be responsible for 10 percent of all admissions to intensive care units (ICUs) worldwide and occurs in nearly a quarter of patients undergoing mechanical ventilation. The mortality rate for ARDS remains high, even though patient outcomes have improved significantly in the last decade, from an estimated hospital mortality of 90 percent to a reported 46 percent.
Prone positioning is now considered first-line therapy for patients with severe ARDS to reduce lung trauma and improve outcomes. Recent studies show that lying face-down for up to 16 hours a day can improve oxygenation and decrease mortality.
An article in AACN Advanced Critical Care provides an overview of how Christiana Care Health System in Delaware updated its procedures and guidelines on prone positioning for patients with ARDS. Christiana Care’s Prone Positioning Interdisciplinary Guidelines are now the standard of care for all five adult critical care units in the health system’s two hospitals.
Christiana Care initially developed guidelines for prone positioning in 2010; physicians determined when patients required prone positioning, and nursing teams developed a plan to implement the move.
A team of providers, nurses, respiratory care providers, physical therapists and other clinicians developed new interdisciplinary guidelines in 2014 and updated them in 2018.
Part of the update was based on clinical practice guidelines on mechanical ventilation in adult patients with ARDS issued in 2017 by the American Thoracic Society, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. The new guidelines strongly recommended the use of prone positioning for patients with severe ARDS.
Co-author Dannette Mitchell, MSN, APRN, ACNS-BC, CCRN, is a critical care clinical nurse specialist at Christiana Care.
“Our guidelines ensure that all team members are involved in the prone-positioning procedure from planning to procedure and recovery,” Mitchell said. “The updated procedures have improved teamwork and efficiency, changing the process from a purely nursing one to one that is interdisciplinary.”
The guidelines, with specific responsibilities for each staff member throughout the process, are included in the journal article “Acute Respiratory Distress Syndrome and Prone Positioning.”
The article is part of a symposium published in the winter 2018 issue of the peer-reviewed journal that focuses on advances in evidence-based pulmonary care. The collection of articles provides some of the latest evidence to inform nursing care of patients with respiratory illnesses and conditions, as well as ideas for implementing practice changes. Other articles address the following:
- End-tidal capnography
- Tracheostomy care and pleural chest tubes
- Ventilator technology
Co-author Maureen Seckel, MSN, RN, APRN, ACNS-BC, CCRN, CCNS, also served as editor for the symposium. She is lead critical care clinical nurse specialist and sepsis leader at Christiana Care.
“Pulmonary care continues to advance, with improved technology and new techniques,” Seckel said. “A knowledgeable team that uses the latest evidence-based practice is able to provide the best outcomes for patients.”
The American Association of Critical-Care Nurses (AACN), which publishes the journal, has an extensive collection of clinical resources on pulmonary assessment, dynamics and care for patients on mechanical ventilation, including AACN Practice Alerts related to pulmonary care. The AACN Practice Alerts are available to download at no cost on the AACN website, www.aacn.org/practicealerts, once you sign in.
AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles and columns of interest to critical and progressive care clinicians.
Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.
About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.
About the American Association of Critical-Care Nurses:Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.
American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme