Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study.
Natalie L McEvoy, Oisin Friel, Jennifer Clarke and 8 others
PMID 36221908WHAT IT FOUND
Fewer prone ICU patients developed pressure ulcers after a bundle with more frequent head turns, open gel head ring, prophylactic dressings, pressure redistribution air mattress, staff education and bedside training, from 80% to 60%.
Total ulcers stayed high, 34 to 32.
Key findings
01In the pre-intervention group, 80% of patients (16) developed pressure ulcers, with 34 pressure ulcers in total.
02In the post-intervention group, 60% of patients (12) developed pressure ulcers, with 32 pressure ulcers in total.
03The paper reports a 25% reduction in patients developing a pressure ulcer and a 6% decrease in total pressure ulcers.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The pre and post groups were different convenience samples of 20 patients each, recruited 7 months apart, so changes over time could explain the difference. Illness severity, body mass index, sex mix, corticosteroid use, prone session number and total prone hours differed between groups. Care bundle adherence was not formally assessed. Pressure ulcer grading relied on retrospective electronic records, with no blinded assessor or inter-observer agreement. The study was single-centre and small.
The easy way to misread this
Do not read the drop from 80% to 60% as proof the bundle caused fewer pressure ulcers. The study compared different patients 7 months apart, did not measure bundle adherence, and changed several practices at once, including more frequent head turns, open gel head ring, prophylactic dressings, pressure redistribution air mattress, staff education and bedside training.