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Pressure injuries in mechanically ventilated COVID-19 patients utilising different prone positioning techniques - A

Cara Woolger¹, Thomas Rollinson², Fiona Oliphant¹

¹Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia.

Intensive & Critical Care Nursing

|January 12, 2024

Insights

The Swimmers Position approach for mechanically ventilated COVID-19 patients resulted in fewer pressure injuries (PIs) compared to the Face Down method. Most PIs were minor and healed by hospital discharge.

Area of Science:

Critical Care Medicine
Pulmonology
Patient Safety

Background:

Mechanically ventilated COVID-19 patients often require prone positioning to improve oxygenation.
Pressure injuries (PIs) are a common complication during prone positioning.
Different prone positioning techniques may influence PI incidence.

Purpose of the Study:

To compare the incidence and distribution of pressure injuries (PIs) between two prone positioning methods: Face Down and Swimmers Position.
To determine the prevalence of PIs at intensive care unit (ICU) and hospital discharge.

Main Methods:

Prospective observational study in a quaternary ICU involving adult patients with COVID-19-associated acute lung injury.
Compared PI incidence and anatomical distribution during ICU stay and at discharge for Face Down vs. Swimmers Position.
Investigated 206 prone episodes in 63 patients between September 2021 and February 2022.

Main Results:

The Face Down group had a significantly higher incidence of PIs (76%) compared to the Swimmers Position group (45%) (p=0.02).
Face Down positioning was associated with more PIs per patient (median 1 vs 0, p=0.04) and a higher rate of facial PIs (p=0.002).
Over 80% of PIs were Stage 1 or 2; 29% healed by ICU discharge and 73% by hospital discharge.

Conclusions:

Swimmers Position demonstrates a significantly lower incidence of pressure injuries compared to the Face Down approach.
The findings support current guidelines recommending Swimmers Position for mechanically ventilated COVID-19 patients.
The low prevalence of PIs at hospital discharge suggests effective management strategies.

Read full analysis

Abstract

Objectives:

To compare the incidence and distribution of pressure injuries (PIs) with two approaches to prone positioning for mechanically ventilated COVID-19 patients, and to determine the prevalence of these PIs on intensive care unit (ICU) and hospital discharge.

Design:

A prospective observational study.

Setting:

Adult patients admitted to a quaternary ICU with COVID-19-associated acute lung injury, between September 2021 and February 2022.

Main Outcome Measures:

Incidence and anatomical distribution of PIs during ICU stay for "Face Down" and "Swimmers Position" as well as on ICU and hospital discharge.

Results:

We investigated 206 prone episodes in 63 patients. In the Face Down group, 26 of 34 patients (76 %) developed at least one PI, compared to 10 of 22 patients (45 %) in the Swimmers Position group (p = 0.02). Compared to the Swimmers Position group, the Face Down group developed more pressure injuries per patient (median 1 [1, 3] vs 0 [0, 2], p = 0.04) and had more facial PIs (p = 0.002). In a multivariate logistic regression model, patients were more likely to have at least one PI with Face Down position (OR 4.67, 95 % CI 1.28, 17.04, p = 0.02) and greater number of prone episodes (OR 1.75, 95 % CI 1.12, 2.74, p = 0.01). Over 80 % of all PIs were either stage 1 or stage 2. By ICU discharge, 29 % had healed and by hospital discharge, 73 % of all PIs had healed.

Conclusion:

Swimmers Position had a significantly lower incidence of PIs compared to the Face Down approach. One-quarter of PIs had healed by time of ICU discharge and three-quarters by time of hospital discharge.

Implications For Clinical Practice:

There are differences in incidence of PIs related to prone positioning approaches. This study validates and helps better inform current prone position guidelines recommending the use of Swimmers Position. The low prevalence of PIs at hospital discharge is reassuring.

Keywords:

COVID-19 Pressure area care Prone position Wound healing

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