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Complications of prone positioning in patients with COVID-19: A cross-sectional study

Filippo Binda1, Alessandro Galazzi2, Federica Marelli1

  • 1Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.

Intensive & Critical Care Nursing
|July 10, 2021
PubMed

Insights

Prone positioning for COVID-19 patients is safe, but prolonged duration increases the risk of pressure ulcers. Intensive care units should enhance surveillance and prevention strategies for these complications.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Prone positioning is a key intervention for severe COVID-19 patients requiring mechanical ventilation.
  • Understanding complication rates, particularly pressure ulcers, is crucial for optimizing patient care.

Purpose of the Study:

  • To determine the prevalence of complications in COVID-19 patients undergoing prone positioning.
  • To specifically investigate the incidence and risk factors for prone-related pressure ulcers.

Main Methods:

  • A cross-sectional study was conducted in a COVID-19 intensive care unit in Milan, Italy.
  • Included patients with COVID-19 on invasive mechanical ventilation treated with prone positioning.
  • Logistic regression analyzed associations between pressure ulcers and patient variables.

Main Results:

  • 219 proning cycles were performed on 63 patients (mean age 57.6 years, 66.7% obese males).
  • Prone-related pressure ulcers occurred in 30.2% of cycles, bleeding in 25.4%, and device displacement in 12.7%.
  • Increased duration of prone positioning was independently associated with a higher likelihood of pressure ulcers (OR 1.9).

Conclusions:

  • Prone positioning is a safe and feasible treatment for COVID-19 patients, including those who are obese.
  • Obese patients may require increased surveillance and proactive prevention of pressure ulcers.
  • The duration of prone positioning is a significant factor influencing pressure ulcer development.
Abstract

Keywords:
COVID-19Intensive Care UnitsObesityPressure UlcersProne PositionRespiratory Distress Syndrome

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