Pressure injuries in mechanically ventilated COVID-19 patients utlising different prone positioning techniques – A single centre experience

Abstract

Introduction: Prone positioning (PP) may be utilised to improve oxygenation in mechanically ventilated patients with COVID-19 pneumonia. Pressure injuries (PIs) are a well-recognised complication of prolonged PP. It is unclear how best to position prone patients to minimise this risk. Objectives: To ascertain differences in the incidence and distribution of PIs with two prone positions. Methods: An iterative PP guideline for mechanically ventilated patients was developed in a tertiary intensive care unit during a pandemic surge between September and November 2021. PI data was collected prospectively on all prone patients. A default ‘Face Down’ approach utilised a neutral neck position with face resting on a foam pillow and arms resting by sides. After 3 weeks, this default approach was changed to ‘Swimmer’s Position’ which involved the patient’s head turned to the side, one hand resting next to patient’s face and other arm resting by side with 3-hourly turns. An endotracheal anchoring device was the preferred airway securement technique with both approaches. Results: Fifty-one mechanically ventilated patients had 161 prone episodes during this timeframe. Seven patients had both ‘Face Down’ and ‘Swimmer’s Position’ PP. Of the remaining 44 patients, 34 had ‘Face Down’ PP only. Twenty-six (76%) patients developed 55 PIs – cheek (22), chin (8) and nose (5) were the most common PI areas. Ten patients had ‘Swimmer’s Position’ PP only. Four (40%) patients developed 15 PIs – cheek (4), lip (3) and ear (2) were the most common PI areas. The majority (81%) of all PIs were Stage 1 or 2. No PIs required surgical intervention. Overall, fewer patients had PIs with Swimmer’s Position (OR 0.21, 95% CI 0.05, 0.91). Conclusion: ‘Swimmer’s Position’ yielded a lower overall incidence of PIs than ‘Face Down’ PP. The anatomical distribution of PIs differed for these two prone positions.