• ARDS patients

• Respiratory failure patients requiring prone position

• ECMO patients

• Severe COVID-19 patients

• Other critical patients in MICU

• Critical-care hospice integrated cases

Tri-Service General Hospital's Medical Intensive Care Unit (MICU), led by RNs Yu-Ting Lin, Min-Chin Lu, and Ya-Ting Lee, established an ARDS Prone Care model. The 9-bed center is staffed by 25 nurses (nurse-bed ratio 1:2.77), 96% (24) with >2 years' clinical experience, complying with Accreditation Standard 2.4.7. Standard prone position requires ≥5 people (3-4 nurses, 1 respiratory therapist, 1 physician) to turn the patient; repositioning every 2 hours with pillow adjustments to prevent pressure injuries. Comprehensive equipment includes 4 PiCCO/Flow-trac units, 9 dialysis machines, 24/7 X-ray and ultrasound. From 2016-2021, 90 ARDS patients received prone treatment, 26 successfully transferred out. Key indicators: prone rate 84.9%, ECMO 6.6%, post-prone 2-hour ABG rate 84.4%, near-term oxygenation improvement 80%, medium-term 85.5%, pressure injury rate 2.4% (injuries/prone patient-days, far below Asia 16.6%, international 43-57%); endotracheal/vascular catheter dislodgement 0%; VAP rate 0‰; CAUTI 0%. Critical-care hospice rate: 95.9% (2020), 88.2% (2021).

• Standardized 5-person prone team

• Repositioning every 2 hours

• Modified prone pillows prevent pressure injury

• 4 PiCCO/Flow-trac for real-time hemodynamics

• 24/7 ABG monitoring

• Integrated with IM/anesthesia/RT teams

• 9-bed MICU

• 25 nurses (ratio 1:2.77)

• 96% (24) >2 years experience

• 90 ARDS patients prone treated (2016-2021)

• 26 successfully transferred out

• Critical-care hospice 95.9% (2020), 88.2% (2021)

• Prone rate 84.9% (avg severity 38)

• Oxygenation improvement: near-term 80%, mid-term 85.5%

• Pressure injury 2.4% (vs Asia 16.6%, intl 43-57%)

• Endotracheal/vascular catheter dislodgement 0%

• VAP 0‰, CAUTI 0%

• ECMO use 6.6%

• 1-hour ABG completion 83.3%

• 2-hour post-prone ABG 84.4%

• 8-hour ABG during prone 100%

• 1-hour supine ABG 95.5%

• Airway obstruction 0%

• Comprehensive repositioning measures

• Patient oxygenation improvement and recovery

• 26 successfully transferred out

• High medical team satisfaction

• 2016 Medical Center Accreditation passed

• Recognized for COVID-19 dedicated ward support

• Positive public and media feedback

• Oxygenation improvement exceeds intl >70%

• Pressure injury rate better than southern MC 16.6%

• Injury rate better than intl 43-57%

• VAP 0‰ vs France 45%, Asia 22.7%

• References multiple SCI publications

• Expanding to other critical units

• Annual Health Bureau audit "Distinguished"

• 2020-2021 COVID-19 dedicated ward support

• Mass casualty care for Formosa Fun Coast incident

• Black Hawk helicopter rescue support

• Presidential inauguration medical support

• Nepal post-disaster reconstruction training