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Rapid adoption of the ICS/FICM guidance for prone positioning in adult critical care within mechanically ventilated patients: a single centre, retrospective evaluation

Elizabeth King, Graham Barker, Jonathan Grant, Jasmine McAuley, Terry Cordrey, Owen Gustafson


Elizabeth KingOxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, U.K,,

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COVID-19 was a global pandemic that resulted in profound respiratory failure. Following promising results from prone positioning reported in Italy and China for patients with COVID-19, it was rapidly instigated in the United Kingdom for treatment for severe respiratory failure. The anticipated high number of admissions, patient prone positioning requirement and staffing challenges associated with the pandemic resulted in a rapid review of local practice.


This is a single centre, retrospective evaluation of prospectively collected date assessing the safety and feasibility of the rapid adoption of the Intensive Care Society/Faculty of Intensive Care Medicine guidance for prone positioning of the mechanically ventilated adult. This review included adverse events occuring during prone procedures of all patients with COVID-19 who were mechanically ventilated across two ICUs.


Over 12-months, 123 patients were proned with 1,258 procedures using an adapted checklist. There were three adverse events of iatrogenic nature and one accidental extubation. Less than five prone procedures (0.4%) occurred with between five to eight members of staff during the two ‘proning rounds’ rather than with five members of staff as per the guidance. There were no staff injury during the ‘proning rounds’.


The rapid adoption of the ICS/FICM guidance was safe and feasible to undertake the prone procedure in clinical practice during the pandemic. This included the prone procedures being performed by five members of staff led by a critical care physiotherapist.

2022 Journal (Vol. 54 Issue 3)
Journal of the Association of Chartered Physiotherapists in Respiratory Care. Volume 54. Issue 3. 2022. Article on: p15-27
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