- Joined
- Apr 21, 2003
- Messages
- 8,362
- Reaction score
- 18
how long do you give a patient on HFOV/VDR before going prone? or do you ever consider it?
how long do you give a patient on HFOV/VDR before going prone? or do you ever consider it?
At our ICU, if we have much oxygenation problems the go on the Rotabed. They never use the oscillator.
Obvious disclaimer: Never been shown to improve outcomes. We should all know that.
Neither has HFOV/VDR for that matter.
We try an get all fancy, but the bottom line is that many of these patients are probably dead for all intents and purposes when we finally decide to try these "salvage" interventions, anecdotes notwithstanding. This is where the future of ECMO lies IMHO, but those details are still being ironed out.
I'll consider prone positioning in a patient if they still have low sats despite high PEEP and inhaled vasodilators after paralysis, and if they tolerate it, I'll keep them prone for 12-18 hours before turning back around. If that is not enough to recruit when turned back over, it's time to have a tough talk with family.
failing to prove a positive does not necessarily prove the negative. if you have a patient who cannot oxygenate supine, and you flip them prone, and you can oxygenate them, then youve bought time for source control and resolution. ive become really skeptical of looking at extreme measures in the context of mortality. why do you decide 12-18 hours is enough? do you have that much practical experience with it? ive decided ill go three days and reevaluate, but Im still not sure what my endpoints are, although certainly weaning FiO2 has to be the major one. Also, I dont think Ill prone anyone who Im not also oscillating.
Too much risk of instant mortality with proning someone in a unit which does it infrequently. I feel if someone is not responding to the capabilities of a conventional ventilator then go to ECMO.