Q: 44 year old male is in ICU with severe ARDS. Earlier, high PEEP caused pneumothorax and patient required the anterior chest tube. Air leak is still evident on chest tube. Patient is very unstable for transfer to ECMO equipped institution. As a rescue, you decided to try prone positioning. Is chest tube with air leak is an absolute contraindication to prone positioning?


Answer: No - it is a relative contraindication.

Following are the absolute contraindications for prone positioning

• Severe shock or severe hemodynamic instability (MAP less than 65)
• Signs of active bleeding
• Multiple trauma
• Spinal instability
• Pregnancy
• High intracranial pressure 
• Recent tracheostomy within last 2 weeks
• Sternotomy within last 2 weeks

If secured safely, chest tubes/pacemakers/catheters are not contraindicated for prone positioning.