Evidence-based nursing interventions and guidelines for prone positioning of adult, ventilated patients: A systematic review

Abstract

Although the prone positioning of a critically ill patient poses a challenge to nursing interventions, it remains the responsibility of nurses to develop a way to provide the same basic and intensive care to those patients lying prone as to those lying supine. The purpose of this study was firstly to conduct a systematic review of the literature as exploration and description ofthe evidence in support of the beneficial nursing interventions during prone positioning of ventilated patients, and secondly to develop evidence-based nursing guidelines for the nursing process. This exploratory, descriptive and retrospective systematic review includes data from 45 clinical trials, with a total population of 2 148 patients. Data was extracted onto data abstraction forms, assessed for methodological quality and finally summarised in evidence tables. All statistical calculations for the meta-analysis were performed by the RevMan 4.2.8 program. Prone positioning showed significant (p < 0.0001) increases in the partial pressure of oxygen in arterial blood (PaO2) weighted mean difference (WMD =11.43) and the partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio (WMD = 21.58, 95% CI = 11.36; 31.8). The effects of complications, oxygenation and haemodynamic outcomes compared with the different prone-positioning protocols produced inconclusive results. Nursing guidelines for prone positioning were developed based on the best available evidence. The lack of related articles on nursing care of prone positioning was a drawback. Based on these results, recommendations are made towards further study on the nursing care of prone-positioned patients