Procedure

1. Assist patient to prone position.

• Explain the procedure.
• Ensure oxygen therapy and basic respiratory support; make sure there is adequate length of tubing.
• Use pillows, as needed, to support the chest.
• Reverse Trendelenburg position may aid comfort.
• Monitor oxygen saturation.
• Don’t administer sedation to facilitate prone positioning.

2. Monitor oxygen saturation for 15 minutes.

• Goal is SaO₂ 92 to 96%; 88 to 92% if risk of hypercapnic respiratory failure

3. Continue prone positioning.

• Change position every 1 to 2 hours with the goal of keeping the patient prone as long as possible.

• Use timed position changes; ask the patient to switch positions as follows:
  • 30 minutes to 2 hours lying fully prone (bed flat)
  • 30 minutes to 2 hours lying on right side (bed flat)
  • 30 minutes to 2 hours sitting up (30 to 60 degrees) by adjusting head of the bed
  • 30 minutes to 2 hours lying on left side (bed flat)
  • 30 minutes to 2 hours lying prone again
  • Continue to repeat the cycle.
• Monitor oxygen saturations 15 minutes after each position change to ensure oxygen saturation has not decreased.
• Continue to monitor oxygen saturations as per the National Early Warning Score (NEWS).

• When not prone, position patient supine, upright 30 to 60 degrees.
• Titrate oxygen therapy according to patient requirements, as ordered.

If Prone Positioning is Not Tolerated

If oxygen saturations deteriorate, take the following steps:

• Ensure oxygen is connected to patient.
• Increase FiO₂ (per facility policy or prescriber’s order).
• Change patient position; consider return to supine position.
• Escalate to critical care, as appropriate.

• No improvement is seen with change of position.
• The patient is unable to tolerate position.
• Respiratory rate increases to 35 breaths/minute or higher, the patient tires, or uses accessory muscles.