Developing and Implementing a Dedicated Prone Positioning Team for Mechanically Ventilated ARDS Patients During the COVID-19 Crisis.

ABSTRACT

BACKGROUND: The spread of the COVID-19 pandemic in China demonstrated at an early stage the high rate of moderate to severe acute respiratory distress syndrome (ARDS) in the patient population. An intervention that has proved beneficial is the use of prone positioning (PP) for mechanically ventilated patients with ARDS. In one institution, PP was practiced in the medical ICU for this population. However, with the dramatically increasing patient load, staff anticipated that greater capacity to provide this treatment to all qualifying patients would be required. METHODS: A group of physical therapists and occupational therapists (PT/OTs) with ICU experience was redeployed from their regular roles to receive training in PP from an experienced medical ICU (MICU) RN. After intensive training, the team was ready to provide PP to patients. As the workload increased, additional PT/OTs were recruited to the team. A coordinating structure comprising attending pulmonologists screened and advised on appropriate patients. A communication and feedback structure was also implemented. RESULTS: Over a period of seven weeks, the team provided PP to more than 100 patients, with 577 individual interventions in a total of 14 ICUs and one emergency department. There were no major airway or central venous access complications, and only one anterior pressure injury was recorded. CONCLUSION: The rapid implementation of an interdisciplinary PP team in a crisis situation is feasible. It can provide a safe and efficient alternative to adding to the workload of an overloaded nursing staff.