Prone positioning in acute respiratory failure:: survey of Belgian ICU nurses

Objective: To determine the frequency of use and attitudes towards prone positioning in patients with acute respiratory failure. Design and setting: Verbal questionnaire survey in all 79 intensive care units in French-speaking Belgium. Methods: Of the 79 ICUs 29 performed prone-positioning, and 25 agreed to participate in the questionnaire. Measurements and results: Nurses at 9 of the 25 hospitals expressed reluctance to use prone positioning. The time schedules associated with prone positioning varied among the units surveyed, with no consensus. Units used two to six members of staff to turn a patient, with three most commonly being employed. Patients were most commonly positioned with both arms above the head and cushions under the chest, head, and legs, but there was considerable variation among units. The complications most commonly reported were facial edema and decubitus ulcers, with only three of the units reporting accidental extubation. Only two of the units had an established protocol for prone positioning although nurses from 14 of the units felt this would be useful. Conclusions: Prone positioning is approached with some reluctance by ICU staff. If the use of prone positioning in patients with acute respiratory distress syndrome is deemed worthwhile, discussion and development of departmental protocols may facilitate its use.