Procedimiento de VM en Pronoposición
1. Check for contraindications.
  a. Facial or pelvic fractures
  b. Burns or open wounds on the ventral body surface
  c. Conditions associated with spinal instability (eg, rheumatoid arthritis, trauma)
  d. Conditions associated with increased intracranial pressure
  e. Life-threatening arrhythmias
2. Consider possible adverse effects of prone positioning on chest tube drainage.
3. Whenever possible, explain the maneuver to the patient and/or their family.
4. Confirm from a recent chest roentgenogram that the tip of the endotracheal tube is located 2-4 cm above the main carina.
5. Inspect and confirm that the endotracheal tube and all central and large bore peripheral catheters are firmly secured.
6. Consider exactly how the patient's head, neck, and shoulder girdle will be supported after they are turned prone.
7. Stop tube feeding, check for residual, fully evacuate the stomach, and cap or clamp the feeding and gastric tubes.
8. Prepare endotracheal suctioning equipment, and review what the process will be if copious airway secretions abruptly interfere with ventilation.
9. Decide whether the turn will be rightward or leftward.
10. Prepare all intravenous tubing and other catheters and tubing for connection when the patient is prone.
  a. Assure sufficient tubing length
  b. Relocate all drainage bags on the opposite side of the bed
  c. Move chest tube drains between the legs
  d. Reposition intravenous tubing toward the patient's head, on the opposite side of the bed
Turning procedure
1. Place one (or more) people on both sides of the bed (to be responsible for the turning processes) and another at the head of the bed (to assure the central lines and the endotracheal tube do not become dislodged or kinked).
2. Increase the FiO2 to 1.0 and note the mode of ventilation, the tidal volume, the minute ventilation, and the peak and plateau airway pressures.
3. Pull the patient to the edge of the bed furthest from whichever lateral decubitus position will be used while turning.
4. Place a new draw sheet on the side of the bed that the patient will face when in this lateral decubitus position. Leave most of the sheet hanging.
5. Turn the patient to the lateral decubitus position with the dependent arm tucked slightly under the thorax. As the turning progresses the nondependent arm can be raised in a cocked position over the patient's head. Alternatively, the turn can progress using a log-rolling procedure.
6. Remove ECG leads and patches. Suction the airway, mouth, and nasal passages if necessary.
7. Continue turning to the prone position.
8. Reposition in the center of the bed using the new draw sheet.
9. If the patient is on a standard hospital bed, turn his/her face toward the ventilator. Assure that the airway is not kinked and has not migrated during the turning process. Suction the airway if necessary.
10. Support the face and shoulders appropriately avoiding any contact of the supporting padding with the orbits or the eyes.
11. Position the arms for patient comfort. If the patient cannot communicate, avoid any type of arm extension that might result in a brachial plexus injury.
12. Auscultate the chest to check for right mainstem intubation. Reassess the tidal volume and minute ventilation.
13. Adjust all tubing and reassess connections and function.
14. Reattach ECG patches and leads to the back.
15. Tilt the patient into reverse Trendelenburg. Slight, intermittent lateral repositioning (20-30º) should also be used, changing sides at least every 2 hours.
16. Document a thorough skin assessment every shift, specifically inspecting weight bearing, ventral surfaces.

Messerole, E, Peine, P, Wittkopp, W, et al. The pragmatics of prone positioning. Am J Respir Crit Care Med 2002; 165:1359. Official Journal of the American Thoracic Society © American Thoracic Society.