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Pressure injury incidence and impact on patients treated with prone positioning for COVID-19 ARDS

Rashid Nadeem1, Nivea Chirayath-Wilson2, Jeeshal Priya D'souza2

  • 1Department of Intensive Care, Dubai Hospital, Dubai, UAE.

Journal of Wound Care
|August 12, 2023
PubMed

Insights

Pressure injuries (PIs) are more common in COVID-19 acute respiratory distress syndrome (ARDS) patients treated with prone positioning. This increases ventilator, ICU, and hospital stays, negatively impacting clinical outcomes.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • COVID-19 acute respiratory distress syndrome (ARDS) often necessitates prone positioning to improve oxygenation.
  • The risk of pressure injuries (PIs) in critically ill patients, particularly those undergoing prone positioning, requires investigation.
  • Understanding the impact of PIs on clinical outcomes is crucial for optimizing patient care.

Purpose of the Study:

  • To determine the incidence of pressure injuries (PIs) in patients with COVID-19 ARDS treated with prone positioning.
  • To assess the impact of PIs on clinical outcomes, including mortality and length of stay.

Main Methods:

  • A comparative study categorizing patients with COVID-19 ARDS into prone positioning (cases) and non-prone positioning (controls) groups.
  • Data collection included demographics, clinical variables, and outcome measures such as mortality and intensive care unit (ICU) length of stay.
  • Statistical analysis employed Fisher's exact test for categorical variables and Mann-Whitney U test for continuous variables to compare PI incidence and outcomes.

Main Results:

  • The study included 212 patients (104 prone, 108 non-prone).
  • The overall incidence of PIs was 35.4% (75 patients).
  • PIs were significantly higher in the prone group (49%) compared to the non-prone group (22%; p=0.001). Patients in the prone group also experienced longer ventilator, ICU, and hospital stays.

Conclusions:

  • Pressure injuries are more prevalent in COVID-19 ARDS patients treated with prone positioning.
  • The occurrence of PIs in this population adversely impacts clinical outcomes, prolonging the length of stay on ventilators, in ICUs, and in hospitals.
Abstract

Keywords:
COVID-19acute respiratory distress syndromeintensive care unitpressure injuriesprone positioningwoundwound carewound dressingwound healing

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