The Effect of Prone Position Use Ventilator-Associated Pneumonia in Intensive Care Patients
Condition: Intensive Care Unit Syndrome
MeSH terms: Pneumonia; Pneumonia, Ventilator-Associated
Study type: Observational

Summary: 
      The aim of this experimental study was to investigate the effect of prone position use on
      ventilator values, blood gas and ventilator-associated pneumonia in intensive care unit
      patients. Between June 2021 and January 2022, 40 trials and 40 control patients were included
      in the intensive care units of two private hospitals and received mechanical ventilation
      support. The mechanical ventilator values, arterial blood gases and ventilator-related
      pneumonia conditions were evaluated and followed for at least 5 to 10 days just before the
      position was given by comparing the prone position (PP) and the patients were brought back
      into the supine position. The data were collected using 'Patient Follow-up Charts', 'Clinical
      Pulmonary Infection Score', 'Braden Pressure Half Risk Assessment' and 'Ramsey Sedation
      Scale' prepared in line with patient introduction form and evidence-based guidelines. In
      addition, life findings, cultural results and blood gas analyses were performed. Statistical
      analysis was performed using the 'NCSS (Number Cruncher Statistical System) 2007 (Kaysville,
      Utah, USA)' program. 'Descriptive statistics, parametric and nonparametric tests' were used
      to evaluate the data. The level of statistical signiation was considered 'p<0.05'.
    

Detailed description: 
      Patients hospitalized in intensive care units are intubated and taken to mechanical
      ventilation support due to reasons such as inability to maintain airway patency, increase in
      respiratory/myocardial workload, and insufficient gas exchange. One of the strategies used to
      increase the effectiveness of mechanical ventilation therapy is the prone position (PP)
      application. In order to increase lung capacity and improve oxygenation in acute lung
      failure, the prone position was first applied in mechanical ventilation in the 1970s. Studies
      have shown that the prone position is protective against preventing ventilator-induced lung
      damage, and it has been found to increase PaO2/FiO2 in 70% of intensive care patients with
      severe hypoxemia receiving MV support. The reduction of the pressure on the lungs and the
      more homogeneous lung perfusion are effective in protecting the lungs in patients with prone
      position. Prone positioning of intensive care patients; It includes the risk of serious
      complications such as endotracheal tube obstruction, unplanned extubations, tachy and
      bradyarrhythmias, loss of venous and arterial access, cardiac arrest and pressure ulcer
      development in anterior body surface areas.

      Positioning is one of the practices that nurses use by using their professional knowledge and
      skills. The positive effects of the position given to the patients in the intensive care unit
      on treatment and care are stated. Nurses continue to play a key role in the follow-up and
      treatment of patients who are placed in the prone position under mechanical ventilation
      therapy, from the continuous evaluation of the patients to the implementation of care
      practices, to provide the best clinical results.

      In this study, a randomized controlled experiment was planned to determine the effect of the
      prone position by evaluating the mechanical ventilator values, blood gas and
      ventilator-associated pneumonia status before the position is applied, during the position
      and after the patients are brought back to the supine position by comparing the groups with
      and without the prone position.

      The aims of the research;

        -  How prone position affects ventilator mode values

        -  How the prone position affects blood gas results,

        -  To examine how prone position affects the rate of development of ventilator-associated
           pneumonia.
    

Intervention name(s): practicing prone position
Intervention type(s): Other
Intervention description(s): Wash your hands. Prepare the materials. Before starting the procedure, inform the patient and explain the procedure. Ensure patient privacy. Raise the guardrail opposite the work area. Take the proper posture. Pay attention to body mechanics. Lay the patient on their back in the middle of the bed. Place a pillow under the patient's head to cover their shoulders. Extend arms to side of body with elbows slightly bent inward (flexion). Place a pillow under your arms. Place roller in palm. Place a thin pillow or a thinly folded towel/sheet under the waist. Place a thin towel under the knees. Support the bottom of the ankles with a pillow. Support the soles of the feet with a foot board. Raise the guardrail on the working side. Inform the patient that they can stay in this position for a maximum of 2 hours.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The research was carried out between June and December 2021 in the 14-bed and 26-bed
        general intensive care units of two private hospitals on the European side of Istanbul.

        Power analysis was performed with the 'G*Power (v3.1.7) program' in the sample calculation.
        In general, studies should have 80% power. The power of the study is expressed as '1-β (β =
        II type error probability)'. Evaluations to be made with two independent groups; Since it
        is assumed to have a large effect size (d=0.8), according to the calculation made, it was
        determined that there should be at least 26 people in the groups at the level of 'α=0.05'
        according to Cohen's effect size coefficients. Considering that there may be losses during
        the study process, 40 people were included in each group.
      
Keywords: prone position; Intensive care; ventilators mechanical; blood gas; ventilator- associated pneumonia