An ICU client with severe ARDS has PaO2/FiO2 ratio 95 on FiO2 100 percent and PEEP 14. The team prepares to initiate prone positioning. Which monitoring action is most important during proning?
1Confirm ETT depth and patency before, during, and after the turn✓ Correct answer
2Discontinue sedation to allow neurologic assessment during prone
3Reduce PEEP to facilitate the position change
4Limit prone position to under 4 hours to prevent injury
Explanation
Prone positioning in severe ARDS (P/F under 150 on adequate PEEP) for at least 16 hours per session reduces mortality (PROSEVA trial). The most catastrophic complication is unplanned extubation or ETT displacement during the turn. The nurse must confirm ETT position and security before the turn, designate one team member to control the airway during the turn, and reconfirm bilateral breath sounds and ETT depth after. Sedation and paralysis are CONTINUED to prevent ventilator dyssynchrony. PEEP is maintained or increased — not reduced. Sessions are 16+ hours, not under 4.