A Bundle of Interventions to Prevent Pressure Ulcers During Prone Position in Adult Patients With Acute Respiratory Distress Syndrome: Results of a French Stepped-Wedge Randomized Controlled Trial.
Lucile Gay, Laure Huot, Hodane Yonis and 25 others
PMID 40509643WHAT IT FOUND
The bundle of pressure ulcer prevention measures during prone positioning did not show a reduction in new pressure ulcers at day 7.
Nurses should not assume this bundle works.
Key findings
01The bundle did not show a reduction in new pressure ulcers at day 7: 63.9% of control patients and 54.8% of experimental patients had one.
02The experimental period used all six specific preventive measures in 91.8% of patients, versus 1.2% in the control period.
03Expert picture review disagreed on 42.8% of new pressure ulcers, so the accuracy of pressure ulcer assessment was uncertain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study analysed 156 patients instead of the planned 180, so it may have lacked power. Expert photograph review disagreed in 42.8% of cases, and the authors said this precluded reliable pressure ulcer staging. Many skin injury data were missing because nurse and expert assessments differed greatly. Pressure ulcers at inclusion were more common than the authors expected. Some preventive measures were already part of routine care, so the control and experimental periods overlapped. Missing primary outcome data were replaced by the last available recorded assessment. The trial was done in nine centres in France, so results may not apply to other settings. COVID-19 interrupted enrolment, and patients were not consecutive after the trial resumed. Eye complications were assessed without a pre-intervention baseline.
Declared interests
The study was sponsored by the Hospices Civils de Lyon and funded by a French Ministry of Health grant (PHRIP-16-16-0223). The authors declared no conflicts of interest.
The easy way to misread this
Do not read the lower pressure ulcer occurrence at ICU discharge as proof the bundle works. The primary day 7 outcome showed no difference, and the study only planned statistical testing for that outcome.