Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.

The mortality associated with acute respiratory distress syndrome (ARDS) remains high. It has been suggested that use of the prone position may improve survival. However, approaches to the use of the position are often haphazard. The development of clinical guidelines indicating the need for the prone position in ARDS and the process by which the manoeuvre may be performed were thought to be important for two reasons. Primarily, we sought to improve oxygenation through the use of the prone position whilst promoting patient safety. Secondly, we wished to standardize our approach to the use of the prone position and make recommendations for practice so that its use was no longer seen as a last resort in the management of ARDS. The process associated with the development of clinical guidelines is first described. This is followed by presentation of the clinical guidelines. Included in these are the criteria and discussion which indicate consideration of the prone position, potential exclusion criteria, pre-turn considerations, the turning technique, monitoring the effectiveness of the prone position, passive movements and limb positioning and, finally, documentation of the problems associated with use of the prone position. The paper concludes with discussion concerning the potential for future research in this area.