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Proning Obese Patients Challenges — FRCA Final MCQ

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ModerateIntensive Care MedicineProning Obese Patients ChallengesFRCA Final

A 55-year-old man on the ICU with septic shock and ARDS requires prone positioning. His BMI is 45. What specific challenge does obesity present for prone positioning?

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Correct answer: B — Increased risk of abdominal compression causing raised IAP, reduced venous return, and cardiovascular compromise

Proning obese patients presents specific challenges: (1) abdominal compression increasing intra-abdominal pressure (potentially causing ACS), (2) reduced venous return from IVC compression, (3) cardiovascular compromise (reduced cardiac output), (4) increased risk of pressure injuries due to higher body weight, (5) practical difficulties with safe turning (requires more staff, specialised equipment/mattresses), and (6) potential for endotracheal tube displacement. Despite these challenges, obesity is NOT a contraindication to proning – obese patients may actually derive particular benefit from proning (improved FRC by relieving diaphragmatic compression). Adequate planning and staffing are essential.

Reference: ICS – 2024 – Prone positioning guidelines; AAGBI – 2015 – Obesity perioperative management