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ning occurs about this, if necessary reposition the me-
chanical ventilator.
•
•
Lateralize the patient carefully, at the command of the
leading professional. Turn the patient into prone po-
sition, with cushions positioned below the chest and
pelvis.
Care and monitoring in prone position
43,44
•
•
Bed in reverse Trendelemburg position (25°30°).
•
•
Check the placement of the endotracheal tube.
•
•
Reposition the dome of the arterial line on the sup-
port, adjusting the level and resetting.
•
•
Check the correct positioning of the chest and pelvis
cushions (the abdomen should be free).
Electrodes on the back and swimmer position
43,44
•
•
Fix the electrodes on the arms on the back of the patient
correctly; (in the revers RA and RL position on the pos-
terior thorax to the right of the patient and LA and LL
on the posterior thorax to the left of the patient).
•
•
Place the patient in “the swimmer position”: One of
the limbs should be raised to 80° of abduction with
the elbow flexed at 90°, the face should be turned to
the raised limb, and the other arm should remain at
the side of the body.
•
•
Alternate the side of the swimmer position every 2
hours.
•
•
Position the circular cushion under the patient’s face,
avoiding facial injuries, and a cushion on the palm of
the hand of the raised limb, extending the fist and main-
taining the flexion of the fingers. Put a cushion below
the region of the knees, on the anterior portion of the
legs in order to keep the ankles in neutral position.
•
•
Unclamp and check the tubes and drain.
•
•
Perform monitoring and relief of pressure points on
bony protuberances while in ventral position.
•
•
Assess the resumption of enteral diet after 1 hour in
the prone position and monitor the presence of ab-
dominal distension.
Return to the supine position
Return to supine positioning should consider the same
precautions performed in prone.
43,44
F
inal
considerations
It is likely for prone positioning to be increasingly used
in daily practice, being essential a properly trained team
and a well-established care protocol in order to make the
position a safe technique.
R
esumo
Boas práticas da manobra de prona à beira do leito: cons-
trução de um protocolo de cuidados
No último ano, o interesse pela posição prona no trata-
mento da síndrome da angústia respiratória aguda (Sara)
ressurgiu com a demonstração da redução da mortalida-
de por um grande estudo clínico randomizado. Os rela-
tos, na literatura, sugerem que a incidência de eventos ad-
versos é significativamente reduzida com uma equipe
treinada e experiente no processo. O objetivo desta revi-
são é revisitar as evidências atuais, discutir e propor a
construção de um protocolo de cuidados para esses pa-
cientes. Foi realizada busca nas principais bases eletrôni-
cas: Medline, Lilacs e Cochrane Library. A posição prona
é cada vez mais utilizada na prática diária, sendo impres-
cindível a presença de uma equipe adequadamente trei-
nada e um protocolo de cuidados bem estabelecido.
Palavras-chave:
síndrome do desconforto respiratório do
adulto, síndrome da angústia respiratória aguda, decúbi-
to ventral, insuficiência respiratória, terapia intensiva.
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