Table 2.

Guideline for prone positioning.

Timing
1. Consider placing patient in a prone position if they require more than 2 L/min of O2 by nasal cannula to maintain SaO2 ≥ 95 and/or respiratory rate is >30 per minute for significant portion of time.
Determine Following Prior to Repositioning
1. Ability to move independently in bed. 2. Mental status 3. Contraindications to placing in prone position.
Monitoring and Positioning of the Patient
1. EKG leads are placed if clinically indicated. 2. SpO2 probe (continuous) should be placed on patient if not already in use. 3. Place FHR straps in non-pressure point areas once the patient is in the prone position. 4. Verify that oxygen supply tubing is unobstructed. 5. Pillows may be placed under the hips, or under the legs, as needed, for comfort. 6. Place call bell and phone within reach 7. Consider rotating position every 4 h. However, the patient may remain in the prone position for as long as they can tolerate it if the patient desires. 8. Increase O2 supply to patient whenever repositioning of the patient is performed.
Documentation
1.SpO2 2.Oxygen device and oxygen rate (L/min of O2) 3.Respiratory rate 4.Presence of dyspnea should be assessed before and after placing patient in the prone position.
Discontinuation of Prone Position
1. No improvement within 10–15 min of being placed in the prone position. 2. Worsening of hemodynamic decompensation once in the prone position 3. If FHR is unable to me monitored, continue discontinuation on case-by-case basis. 4. Significant improvement is maintained when placed back in the supine position.
Consider Transfer to ICU
1.Inability to maintain oxygen saturation ≥ 95% (PaSO2) with supplemental oxygen or rapidly escalating supplemental oxygen need. 2.Hypotension (MAP <65) despite appropriate fluid resuscitation (~1000 mL bolus of crystalloid fluids). 3.Evidence of new end-organ dysfunction (eg, altered mental status, renal insufficiency, hepatic insufficiency, cardiac dysfunction, etc.)