Preparing a Patient for Prone Position in Surgery

Pre-Positioning Assessment and Stabilization

The Society of Critical Care Medicine recommends stabilizing the patient hemodynamically and optimizing volume status before prone positioning 1, 2
Ongoing vasopressor therapy is not a contraindication to prone positioning, as the intervention is generally well tolerated hemodynamically, according to the American Thoracic Society 1, 3
Patients may experience improved right ventricular load in prone position, as suggested by the European Society of Intensive Care Medicine 3

The American College of Surgeons states that prone positioning should only proceed after interdisciplinary risk-benefit assessment if any of the following exist: open abdomen 1, spinal instability 1, increased intracranial pressure (ICP) 3, cardiac arrhythmias with hemodynamic consequences 2, or shock 1

The Society of Critical Care Medicine recommends individual consideration of benefits versus risks for patients with abdominal surgery, abdominal pathologies, or abdominal obesity, as they may require special consideration 1, 2
Patients at risk of increased ICP must have continuous or close monitoring during positioning, with head positioned centrally and lateral rotation avoided, as advised by the Neurocritical Care Society 1, 2

The World Health Organization recommends applying prophylactic foam dressings to vulnerable areas before positioning to minimize pressure ulcer risk 1, 2
The American College of Surgeons suggests planning for careful examination of all at-risk areas during and after prone positioning 1, 2

The European Society of Intensive Care Medicine recommends using complete (180°) prone positioning rather than incomplete prone positioning, as it has stronger effects on oxygenation and improved clinical outcomes 1, 2

The American Thoracic Society advises monitoring hemodynamics continuously during and after positioning, as well as maintaining continuous or close ICP monitoring for patients with ICP risk 1, 2
The Society of Critical Care Medicine recommends regularly inspecting pressure points throughout the procedure to detect early signs of pressure injury 1, 2
The American College of Chest Physicians suggests applying optimized ventilation principles, including limitation of tidal volumes, prevention of derecruitment, and integration of spontaneous breathing components when appropriate 1, 2
Prone positioning and PEEP have additive effects on improving oxygenation, as reported by the European Society of Intensive Care Medicine 3

The American College of Surgeons warns against proceeding with prone positioning without first securing all tubes and lines, as dislodgement during turning is a preventable catastrophe, and assuming vasopressor use is a contraindication, as optimization of volume status is necessary but proceeding with positioning may be appropriate 1, 3
The Society of Critical Care Medicine advises against using incomplete prone positioning, as there is no evidence for clinical benefit and complete positioning has superior oxygenation effects 1, 2
The World Health Organization recommends not neglecting pressure point protection, as prone positioning significantly increases pressure ulcer risk and prophylactic measures must be taken before positioning 1, 2