Ocular Complications During Prone Positioning Ventilation in Critically Ill Adults: A Systematic Review.
Zongheng Jiang, Peipei Gu, Jianming Wang and 3 others
PMID 42626835WHAT IT FOUND
Critically ill adults receiving prone positioning had ocular surface problems, especially exposure keratopathy.
Nurses should check eyelid closure, conjunctival swelling, corneal clarity and pressure on the face before, during and after proning.
Key findings
01In a study of patients who all received prone positioning, exposure keratopathy was identified in 129 of 252 patients (51.2%) by fluorescein staining and slit-lamp examination.
02Two studies reported intraocular pressure increases rather than clinical ocular complication counts, including median non-dependent-eye pressure rising from 14 mmHg before prone positioning to 32 mmHg at the end of the session.
03In a multivariable analysis, lagophthalmos, deeper sedation, higher positive end-expiratory pressure, longer prone positioning duration, more frequent prone positioning sessions, and increased ocular secretions were independently associated with exposure keratopathy.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The studies differed in populations, prone-position exposure, eye definitions, assessment methods and measurement times, so the reported proportions and pressure changes could not be pooled or directly compared. Baseline eye status was not consistently documented. It was often unclear whether a finding was new during prone positioning or already present. Several studies were mixed intensive care cohorts without a prone-specific denominator. The contribution of prone positioning could not be separated from critical illness, mechanical ventilation, sedation and other treatments. Most studies were small observational designs. Small samples and non-comparative designs made selection bias, information bias and residual confounding likely. Eye-care practices, eyelid-closure assessment, head position, protective barriers and protocol adherence were inconsistently reported. Only English-language studies were included. Relevant evidence published in Chinese or other languages may have been omitted.
Declared interests
The authors reported nothing to declare. The protocol was registered in PROSPERO.
The easy way to misread this
Do not read 51.2% as the incidence of injury caused by prone positioning. Baseline eye status was often not documented, some cohorts were mixed intensive care populations without prone-specific denominators, and increased intraocular pressure was a physiological change, not a proven clinical complication.