Acute Respiratory Distress Syndrome & Proning
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Acute Respiratory Distress Syndrome is defined as a severe acute lung injury in which there is a loss of aerated tissue and an increase in lung weight and pulmonary vascular permeability (Acute Respiratory, n.d.). ARDS is considered one of the most severe forms of lung injury and is associated with high mortality rates (Harcombe, 2004). In many Intensive Care Units throughout the world, proning is used to help support patients with ARDS. Therefore, the purpose of this paper is to discuss and examine information regarding nursing care associated with patients that have been diagnosed with ARDS and are in the prone position.
Summary of an Article
The article chosen for this assignment was published on January 21st, 2004, in the Nursing Standard Journal (Harcombe, 2004). The author, Harcombe (2004), addressed the risks and benefits regarding prone positioning in ARDS patients along with the nursing care required for these patients. ARDS, a form of respiratory failure, can be caused directly or indirectly. Aspiration, pneumonia, fat emboli, and inhalation are all forms of direct injury to the lungs. Sepsis, burns, drug overdose, and shock are forms of indirect injury to the lungs. There are two main phases associated with ARDS, the acute phase and the chronic phase. The acute phase is characterized by damage to the alveoli and impaired function and production of a lipoprotein called surfactant. The chronic phase is characterized by thickening of the epithelium, endometrium, and interstitial space. The clinical signs of ARDS are hypoxemia, respiratory distress, increased oxygen requirements, and bilateral infiltrates noted on a chest x-ray (Harcombe, 2004).
In the article, Harcombe (2004), states that there are two main treatments for ARDS are fluid management and respiratory support. Fluids management is vital for maintaining stable hemodynamics along with adequate cardiac output. Respiratory support is provided in order to give the lungs adequate recovery time after an acute insult. Intubation, mechanical ventilation, and prone positioning are all methods of providing respiratory support for a patient experiencing ARDS. Prone positioning has been encouraged for over two decades in order to help improve oxygenation in patients with an acute lung injury. The use of prone positioning also helps to reduce the amount of FiO2, PEEP, and inspiratory and expiratory pressure needed with mechanical ventilation (Harcombe, 2004).
When a patient is placed in a prone position, Harcombe (2004) states that the patient can lay prone for up to 20 hours a day or as long as tolerated. Placing a patient in the prone position requires various healthcare professionals to be present. A nurse or health care professional must be placed at areas in which there is an invasive line, endotracheal tube, or other critical monitoring devices. Complications regarding the prone position are intolerance of the position, self-extubation, difficulties in monitoring the patient, and severe facial edema. Most patients in the prone position require a greater amount of sedation and paralytics due to this being an unnatural and uncomfortable position (Harcombe, 2004).
Despite the majority of evidence-based literature supporting prone positioning, the practice is not utilized nearly as often as it should be. The reluctance to prone position a patient may be due to the unpredictability of the position, the instability involved in turning the