Prone Positioning

For the last two years — and long before COVID-19 began its spread across the world — IUPUI’s Rebecca Ellis led a collaborative project with team members from IU Health that applies best-practice evidence for managing acute respiratory distress syndrome (ARDS) using a supportive intervention called proning.

Ellis has not been surprised to see this technique emerge as a recommended practice for COVID-19 patients.

“Proning is a supportive intervention that has been used for decades and is the best practice for treatment of ARDS, a potentially life-threatening condition that causes fluid build-up in the lungs, limiting oxygen exchange,” said Ellis, an associate professor and assistant dean for graduate programs and Doctor of Nursing Practice coordinator at the IU School of Nursing. “With proning, patients are positioned on their stomachs, and the position, combined with gravity, helps the lungs expand and improve oxygen exchange.”

ARDS-like symptoms are seen in a significant number of COVID-19 cases, affecting the lungs and causing shortness of breath, contributing to the patient’s need to be in critical care. 

“Proning is helpful for people with COVID-19 respiratory symptoms, because people can have improved outcomes from proning,” Ellis said. “In some cases, proning may even help prevent patients from needing to be put on ventilators. With ventilators in short supply in some areas, using innovative and evidence-based strategies can be effective way to deliver high-quality care.”

Patients may be proned using specialty beds, but even before the pandemic hit, these beds could be in limited supply. With COVID-19 cases impacting hospitals, they may not even be available.

As part of the project with IU Health’s Carmen Davis and Terrie Beeson, Ellis’s team developed an innovative solution to help prone patients with ARDS using a static air overlay mattress. The mattresses are specially designed to redistribute pressure and minimize skin pressure injuries. As the pandemic continues, this technique could be a valuable solution for hospitals caring for patients with COVID-19 when resources are limited and patients are remaining in the prone position for longer periods of time.

“Our technique is a timely intervention that bridges the gap between how we get someone proned and how we do it in a way that doesn’t increase further risk of other problems,” said Davis, a critical care clinical nurse specialist at IU Health University Hospital. “We know that placing the patient in prone position is a supportive intervention for ARDS, and with many COVID patients showing ARDS-like symptoms, we can continue to safely and feasibly use the intervention until we know other treatment and management forms are available.”