Are You Flipping Crazy: Indications, Timing and Application of Safe Prone Positioning for ARDS Patients

Kathleen Vollman

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Lecture overview

Prone positioning has been utilised to recruit alveoli to improve oxygenation while preventing complications of ventilator-induced lung injury in patients with ARDS for over 30 years.  Recently with new studies, the use of prone positioning is now considered front line therapy and utilisation of the technique has increased significantly since COVID 19.  With the mortality rate of the ARDS patient remaining at 40%, we need to implement evidence-based practices that work.  This session discusses the physiological mechanisms of the prone position for reducing lung trauma and improving oxygenation.  How a team can successfully build and implement a proning protocol is outlines.  An exploration of the evidence used to define the patient likely to respond to prone positioning, identify the appropriate time to initiate therapy, and time spent in the prone position are discussed.  Evidence-based strategies for turning and sustaining the patient in a prone position are outlined to ensure safety for the patient and healthcare worker.  As practitioners, we have the potential to influence patient outcomes through a safe non-invasive positioning technique. 

Learning Objectives:
By the end of this lecture, the attendee will be able to:

  1. Explain the physiologic rationale for improved oxygenation and reduced lung injury with the prone position in patients with severe ARDS.
  2. Discuss the various strategies to prone patients in times of crisis.
  3. Identify evidence-based strategies for determining when to turn, how long to remain prone while preventing airway and skin complications.
  4. Determine the indications for and strategies to facilitate awake prone position for non-intubated patients.

This lecture is equal to 1 CE Contact Hour, 1 CPD Point, and 1 AMA PRA Category 1 Credit



Additional CME Info

Release Date: February 1, 2020, Termination Date: January 31, 2023

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: EB Medicine designates this internet enduring material for a maximum of 1 AMA PRA Category 1 Credit™ per lecture. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Commercial Support: This activity received no commercial support.

Earning Credit: In order to earn CME credit, the participant must take the pre-test, listen to the lecture, take the CME post-test, and complete the post-test evaluation.

Duration 1 hour(s).

Lecture speaker

Kathleen Vollman

Kathleen Vollman is a Critical Care Nurse Specialist, Educator and Consultant. She has published and lectured nationally and internationally on a variety of topics, such as pulmonary, critical care, prevention of healthcare acquired injuries, work culture, and sepsis recognition & management. From 1989 to 2003 Kathleen functioned in the role of Clinical Nurse Specialist for the Medical ICU at Henry Ford Hospital in Detroit, Michigan. 

Currently her company, ADVANCING NURSING LLC, is focussed on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. 

Kathleen is a subject matter expert for prevention of CAUTI, CLABSI, and HAPI, as well as sepsis recognition/management and the culture of safety for the American Hospital Association and the Michigan Hospital Association. 

In 2004, Kathleen was inducted into the College of Critical Care Medicine, in 2009 she was inducted into the American Academy of Nurses, and in 2012, she was appointed to serve as an Honorary Ambassador to the World Federation of Critical Care Nurses and is currently the financial Director.


CME Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.