Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Yiu KK(1), Lin LP(1), Wong KM(1), Lau TM(1), Yiu SL(1)
Affiliation :
(1)Intensive Care Unit, Princess Margaret Hospital
Introduction :
The prone position has been traditionally used for intubated patients with acute respiratory distress syndrome (ARDS) by improving ventilation and perfusion mismatching. In clinical findings, there was a high rate of acute hypoxemic respiratory failure (AHRF) that progressed to ADRS. The COVID-19 pandemic has brought prone positioning to the forefront of medicine, including widespread implementation of awake prone positioning (APP) in spontaneously breathing non-intubated patients with AHRF to improve their oxygenation. Literatures demonstrate that the use of effectiveness of APP significantly enhances survival rates, efficacy and safety compare with usual care in non-intubated adults with AHRF.
Objectives :
● To identify the core effective factors of APP
● To promote effective APP in AHRF patients to achieve good oxygenation and reduce the intubation rate.
Methodology :
An EBP was performed to explore and determine the effective duration of APP and other core factors that aim to achieve good oxygenation and reduce intubation rate. 3 systemic reviews and 3 RCTs were reviewed and studied.
Result & Outcome :
Findings suggested starting APP once the patient showed the signs and symptoms of AHRF. Moreover, longer APP durations were associated with greater treatment success. The oxygenation was definitely improved if the APP duration was greater than 5 hours per day. Most importantly, the intubation rate was reduced if the APP duration was >=8 hours per day. The core effective factors of APP were to start as early as possible and maintain the position as long as tolerated. Therefore, the key to the therapy is to promote good patient compliance.
Pilot study
Clinical trial run was carried out from January 2023 to September 2023. Education was provided to educating patients once they were included in the APP program by setting the APP sessions and even duration goals together. Afterward, helping them to position, applying pressure relief devices, entertaining them with different diversional activities, and prescribing analgesic or sedative agents if necessary were core ways to boost compliance. Finally, clinician encouragement is a great psychosocial support for patients.
7 patients with AHRF were recruited in the trial of APP. Their APP duration was 6-8.3 hours/day. All patients showed significant improvement in oxygenation.
5 (71.4%) of them did not need intubation. 2 (28.6%) required intubation but not related to the AHRF. All patients can discharge from ICU ultimately.
Ways Forward
Set up workflow and department protocol for full implementation in department.
