Table 1.

PP Indications and Contraindications^*

1. PP is indicated when P/F ratio is < 150 and patient is RASS -5.

2. PP is indicated when P/F ratio < 150 despite ventilator support > 0.60 FiO2 or PEEP > 10 cm H2O.

3. Potential contraindications must be assessed prior to intervening (for example, severe acidemia, hemodynamic instability).

4. Patient must be optimized prior to intervention:  a. Deep sedation and/or paralytics  b. Hemodynamically optimized (pressors)  c. Respiratory (pre-oxygenating, pulmonary toileting, ventilator management, ETT location, and cuff/harness security

^⁎Guidelines for PP describing indication, contraindication, general approach, personnel, timing and safety were created for our institution using the PROSEVA study as guide^5,15.

PP, prone positioning; P/F, partial pressure of oxygen / fraction of inspired oxygen; RASS, Richmond Agitation-Sedation Scale; FiO₂, fraction of inspired oxygen; PEEP, positive end expiratory pressure; ETT, endotracheal tube.

References can be found at the end of this article.