Bed Aids in Prone Positioning to Improve ARDS Oxygenation

About 200,000 people in the U.S. are diagnosed each year with acute respiratory distress syndrome, according to the American Lung Association. Between 30%-50% of these patients die from this serious disease.

“A vast number of research studies show that when mechanically ventilated ARDS patients are positioned prone, their oxygenation improves,” said Andrea K. Anthony, MD, a pulmonologist, allergist and asthma specialist with


Meritas Health Pulmonary Medicine.

Yet, manual positioning is laborious for staff, difficult for family members to watch and can lead to dislodged lines and endotracheal tubes. North Kansas City Hospital is the only hospital in the Northland to use the RotoProne® bed, a specialized mechanical bed that automatically puts patients in a prone position.

Reduced Mortality

“When applied early, putting a patient in a prone position improves response to positive end-expiratory pressure in lung recruitment, improves right ventricular hemodynamics, increases oxygenation and reduces 28-day mortality in severe ARDS,” Dr. Anthony said.

A seminal study, “Prone Positioning in Severe Acute Respiratory Distress Syndrome,” published in the June 6, 2013, New England Journal of Medicine, showed a 51.5% reduction in 28-day mortality from ARDS (16% in the 237-patient prone group versus 33% in the 229-patient supine group) when the patients were put in a prone position for most of the day.

The multicenter, prospective, randomized, controlled trial randomly assigned patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or be left in the supine position. At day 90, mortality in the prone versus supine group was 24% and 41%, respectively. Additionally, the rate of successful extubation was significantly higher in the prone group.

Patients

Sedated and on a ventilator, the patient remains prone in the


RotoProne bed for at least 16 hours in a 24-hour period


over multiple days. Photo: Arjo

According to Dr. Anthony, the RotoProne bed most benefits people who present classically with influenza, a viral illness or bacterial pneumonia that leads to respiratory failure. “These patients can progress to an overwhelming inflammatory response,” she said. “Having these beds means patients have a better chance of survival.”

Dr. Anthony recalled one person with ARDS who previously required a prone position in the RotoProne bed. Ninety days after discharge he began regular 45-minute treadmill walking with no oxygen. “The patient quit smoking and plans to get a flu shot next year,” Dr. Anthony explained.

Those who are not candidates for the bed are people with unstable facial, skull, cervical, thoracolumbar or pelvic fractures; skeletal or cervical traction; or uncontrolled intracranial pressure.

The bed has minimum and maximum weight and height requirements of 88-350 pounds and between 4 feet, 6 inches and 6 feet, 6 inches tall.

RotoProne Bed Features

After securing a patient into the bed, staff slowly and smoothly rotate the bed face down in a continuous motion. Sedated and on a ventilator, the patient remains prone for 16 hours in a 24-hour period over multiple days. The bed rocks back and forth, relieving pressure from fluid-filled lungs. The bed provides several advantages:

• Digital meters track daily and cumulative therapy time
• Touch screen controls program multiple intervals of automated prone therapy
• A tube management system allows staff to securely position endotracheal tubes and other invasive lines, which helps prevent entanglement and separation
• A hand control allows staff to monitor lines and tubes during rotation
• Proper positioning and turning help minimize pressure sores
• If a patient requires CPR, staff can rotate the bed to a supine position in less than 40 seconds.

Andrea K. Anthony, MD

Dr. Anthony earned her medical degree from the University of Kansas School of Medicine, where she was a resident in internal medicine/pediatrics and a fellow in pulmonary medicine.