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Evidence on Measures for the Prevention of Pressure Injuries in Mechanically Ventilated Patients in Prone

Simone Amato1, Daniele Napolitano2, Alessio Lo Cascio3

  • 1Cardiac Intensive Care Unit, Heart Transplant Centre and ECMO Service, San Camillo Forlanini Hospital, 00152 Rome, Italy.

Healthcare (Basel, Switzerland)
|February 27, 2026
PubMed

Insights

Preventive strategies effectively reduce pressure injuries in critically ill patients undergoing prone positioning. Implementing standardized, bundled prevention protocols enhances patient safety in intensive care units.

Area of Science:

  • Critical Care Medicine
  • Patient Safety
  • Nursing Research

Background:

  • Therapeutic prone positioning improves oxygenation in acute respiratory distress syndrome (ARDS).
  • Prone positioning increases the risk of pressure injuries, especially on facial and anterior body areas.
  • Developing effective prevention strategies is crucial for patient safety in intensive care.

Purpose of the Study:

  • To systematically review evidence on pressure injury prevention strategies for mechanically ventilated adult patients receiving prone positioning.
  • To synthesize findings on the effectiveness of various preventive interventions.
  • To inform clinical practice and improve patient outcomes.

Main Methods:

  • Systematic review adhering to PRISMA 2020 and Joanna Briggs Institute guidelines.
  • Comprehensive literature search across multiple databases (PubMed, CINAHL, Web of Science, Scopus, Cochrane Library) and grey literature.
  • Synthesis Without Meta-analysis (SWiM) approach due to study heterogeneity; quality assessed using JBI tools.

Main Results:

  • Eight heterogeneous studies evaluated preventive interventions like prophylactic dressings, repositioning, support devices, and care bundles.
  • Most strategies demonstrated a reduction in pressure injury incidence, particularly in facial and anterior regions.
  • Interventions integrated into structured protocols with staff training and multidisciplinary coordination showed greater effectiveness.

Conclusions:

  • Preventive strategies are effective in mitigating pressure injuries associated with prone positioning in critically ill patients.
  • Standardized, bundled prevention protocols are recommended to enhance patient safety in intensive care settings.
  • Further research may focus on optimizing protocol implementation and evaluating long-term outcomes.
Abstract

Keywords:
care bundlescritical careintensive care nursingpressure injuriesprevention strategiesprone positioningprophylactic dressingsskin integrity

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