Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, Nugent L, Walsh S, O'Connor T, et al.
Journal of wound care. Date of publication 2020 Jun 2;volume 29(6):312-320.
1. J Wound Care. 2020 Jun 2;29(6):312-320. doi: 10.12968/jowc.2020.29.6.312.
Prevention of pressure ulcers among individuals cared for in the prone position:
lessons for the COVID-19 emergency.
Moore Z(1), Patton D(1), Avsar P(1), McEvoy NL(1), Curley G(2), Budri A(1),
Nugent L(1), Walsh S(1), O'Connor T(1).
Author information:
(1)School of Nursing and Midwifery, Royal College of Surgeons in Ireland.
(2)Anaesthetics and Critical Care, Royal College of Surgeons in Ireland.
OBJECTIVE: Pressure ulcers (PUs) involve the destruction of skin and underlying
tissue due to prolonged pressure and shear forces. These ulcers are painful and
significantly reduce a person's quality of life. PUs are also expensive to manage
and impact negatively on the achievement of cost-effective, efficient care
delivery.
METHOD: Prone positioning is a postural therapy that aims to enhance respiratory
function through increasing oxygenation levels. In contemporary clinical
practice, ventilation in the prone position is indicated for patients with severe
acute respiratory distress syndrome. However, despite its advantages in terms of
respiratory function, several studies have examined complications of prone
position ventilation and have identified PUs (facial PUs as well as PUs on other
weight-bearing areas of the body) as a frequent complication in patients who are
already in a precarious medical situation. International data suggest that up to
57% of patients nursed in the prone position develop a PU. The aim of this
clinical review is to identify and review evidence-based recommendations
developed to facilitate the selection and application of preventive interventions
aimed at reducing PU development in patients ventilated in the prone position.
Given the current COVID-19 crisis, this review is timely as intensive care unit
(ICU) patients with COVID-19 require ventilation in the prone position at a level
that is disproportionate to the general intensive care population. Up to 28% of
patients admitted to the ICU with confirmed infection due to severe COVID-19 are
cared for in the prone position. The scope of this review is limited to adult
individuals only.
RESULTS: The skin assessment should be undertaken before proning and following
positioning the patient back into the supine position. Although it is essential
to keep the skin clean and moisturised, using pH-balanced cleansers, there is
inconsistency in terms of the evidence to support the type of moisturiser. Use of
positioning devices in addition to repositioning is recommended to offload
pressure points on the face and body. Further, using dressings such as
hydrocolloids, transparent film and silicone may be of benefit in decreasing
facial skin breakdown.
CONCLUSION: Given the importance of PU prevention in this cohort of patients,
adopting a focused prevention strategy, including skin assessment and care,
offloading and pressure redistribution, and dressings for prevention may
contribute to a reduction in the incidence and prevalence of these largely
preventable wounds.
DOI: 10.12968/jowc.2020.29.6.312
PMID: 32530776 [Indexed for MEDLINE]
