Positioning and proning

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Positioning is important for maintaining oxygenation. Prone positioning (patient lying on their front) can improve oxygenation in some patients with respiratory failure due to COVID pneumonitis, and may improve outcome.

Recommendations

The patient must be able to:

  • adopt the position unaided
  • have ready access to a call bell
  • have no contraindications*

Please refer to proning guidance and patient information on intranet:

  • Guidance for staff here
  • Patient information leaflet here

Contraindications

  • RR>35, PaCO2 >+6.5, accessory muscle use
  • Immediate need for intubation
  • SBP <90 or arrhythmia
  • Agitation or altered mental status
  • Unstable spine/ thoracic injur/ recent abdominal surgery

Relative Contraindications

  • Facial Injury
  • Neurological issues (e.g. frequent seizures)
  • Morbid obesity
  • Pregnancy (2nd and 3rd trimester)
  • Pressure sores/ulcers

When proning is contraindicated or not tolerated, high supported sitting (ie back of the bed up with pillows for support) can help oxygenation and reduce work of breathing.