Pressure injuries in an intensive care unit exclusively dedicated to treating patients with COVID-19: a prospective...

During the COVID-19 pandemic, and as growing numbers of critically ill patients were treated in prone position in COVID-19-dedicated intensive care units (ICUs), the incidence of pressure injuries (PIs) remained relevant. Limited data are available on this topic; this study is intended to add to the literature on these injuries in proned patients who are ventilated during intensive care to contribute to prevention of PIs and better management of these patients.

All patients with acute respiratory distress syndrome treated via invasive mechanical ventilation (endotracheal tube or tracheostomy) in an ICU exclusively dedicated to patients with COVID-19 in Porto Alegre, Brazil from 15 March-10 September 2020 were recruited prospectively following admission to the ICU, including patients who received extracorporeal membrane oxygenation therapy. Patients treated with non-invasive ventilation were excluded. The following variables were analysed: body mass index, immobility time (assessed via duration of mechanical ventilation), nutritional status (assessed by albumin level), age, smoking status, and history of previous PI.

During the study period, 267 patients were admitted to the ICU for COVID-19 support. The median patient age was 61 years, and most were male (58.8%). Most patients (235, 88.0%) had associated comorbidities-186 (69.7%) had multiple comorbidities, and hypertension and diabetes were most common. PIs were present in 150 (56.2%) patients. In 132 patients, the ulcers were examined and ranked according to the Shea classification-65.16% were classified as grade 2. Duration of mechanical ventilation and age were associated with higher ulcer grades. For each additional day on mechanical ventilation, the risk of PIs rose by approximately 7%.

The incidence of PIs in patients on invasive mechanical ventilation in an ICU exclusively dedicated to treating patients with COVID-19 was high. The risk of developing a PI in these conditions rose significantly for each day on mechanical ventilation. Ventilation in the prone position was associated with development of PIs in less common areas.