Complications of prone positioning in patients with COVID-19: A cross-sectional study.
Filippo Binda, Alessandro Galazzi, Federica Marelli and 5 others
PMID 34244027WHAT IT FOUND
Among ICU patients with COVID-19 on ventilators, prone-related pressure ulcers affected 30.2%; longer prone time was linked to more ulcers, while obesity was not linked.
Key findings
01Prone-related pressure ulcers affected 30.2% of patients, and any pressure ulcers affected 42.9%.
02Longer prone position-time was the only significant predictor; increasing mean prone position-time from 24 to 48 hours raised the odds by a factor of 1.4 (95% CI 1.02 to 1.91).
03At least one complication occurred in 32 patients, and 15 of 219 prone position cycles were interrupted.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was a single-centre study in Milan, and the hospital received the most critically ill patients, so the complication rates may not apply elsewhere. The design measured what happened during the study period; it cannot show that prone positioning caused pressure ulcers. Repositioning of the head and arms every two hours was in the protocol but was not routinely recorded, so missed turns could not be analysed. The sample was small, with 63 patients, and the model had modest discrimination (adjusted C-index 0.68) and explained 20% of the variance. BMI was not statistically significant as a predictor, even though the authors described a possible clinical effect.
Declared interests
No specific grant was received, and the authors declared no competing financial interests or personal relationships that could influence the work.
The easy way to misread this
Do not conclude from this paper that obesity is a proven risk factor for prone-related pressure ulcers. The BMI association was not statistically significant, and the only significant predictor was longer prone position-time.