Short-term prone positioning for severe acute respiratory distress syndrome after cardiopulmonary bypass: A case report and literature review

Table 2 Criteria and recommendations for prone ventilation in acute respiratory distress syndrome

Indications	Severe ARDS (PaO2/FiO2 ≤ 100 mmHg with PEEP ≥ 5 cmH2O;); within 48 h after onset of ARDS; mean arterial pressure > 65 mmHg
Contraindications (absolute and relative)	Acial/neck trauma or spinal instability; Raised intraocular pressure or recent ophthalmic surgery, facial trauma, or recent oral maxillofacial surgery in last 15 d; Elevated intracranial pressure; Severe hemodynamic instability, unstable cardiac rhythms; Hemoptysis, unstable airway (double lumen endotracheal tube), new tracheostomy < 15 d, lung transplant; Recent sternotomy or more than 20% body surface burn; Grossly distended abdomen; Second or third trimester pregnancy, grossly distended abdomen; Venous thromboembolism treated < 48 h
Implementation method[8]	Requires 3-5 people, close attention to ETT and central lines; a demonstration video; and checklist are available; Preparation: Preoxygenation, empty stomach, suction; ETT/oral cavity, remove ECG leads and reattach to back, repeated zeroing of hemodynamic transducers; Support and frequently reposition pressure points: Face, shoulder, anterior pelvis
Prone positioning time[31]	12-16 h per protocol
Possible complications	Vascular catheter kinking; Elevated intraabdominal pressure; Facial pressure ulcers, facial edema, brachial plexus injury (arm extension); Cardiac arrest
Time to stop	PaO2/FiO2 remained > 150 mm Hg 4 h after supinating (with PEEP < 10 cm H2O and FiO2 < 0.6)

ARDS: Acute respiratory distress syndrome; ETT: Endotracheal tube; ECG: Electrochemical grinding; FIO₂: Fraction inspired oxygen; PaO₂: Partial pressure of arterial oxygen; PEEP: Positive end-expiratory pressure.