Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation.
E Barja-Martínez, S García-González, E Jiménez-García and 3 others
PMID 36934077WHAT IT FOUND
Oxygenation improved during prone positioning in 63 ICU patients with severe COVID-19 on ventilators, but adverse events occurred in 84.9% of sessions.
Facial pressure injuries affected 38.1% of patients; older age, hypertension, more sessions, and low prealbumin were linked to pressure ulcers.
Key findings
01Adverse events occurred in 118 prone positioning sessions (84.9%), and pressure ulcers on the face affected 38.1% of all patients.
02Pressure ulcers were associated with older age, hypertension, more prone sessions, higher admission severity, higher pressure ulcer risk score, and prealbumin below 21 mg/dL.
03Oxygenation improved during prone positioning: PaO2 and PaO2/FiO2 rose significantly in the first hour, PaO2/FiO2 rose further by 12 hours, and both fell significantly after turning supine.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-centre retrospective descriptive study of 63 patients during the first COVID-19 wave, so it may not apply to other ICUs or to patients with different severity or care practices. The study did not compare prone positioning with a non-prone control group, so it cannot show how much prone positioning alone changed outcomes. Patients were also receiving invasive mechanical ventilation, analgesia and sedation, so the contribution of prone positioning to oxygenation changes cannot be separated from these other treatments. Prealbumin data were missing for 102 of 139 prone sessions because the test was not routinely requested. Data recording may have been incomplete because of pandemic workload, hyper/hypotension events were not separated, and pressure injury severity was not classified.
Declared interests
This study did not receive any funding, and the authors declared no conflicts of interest.
The easy way to misread this
Do not conclude prone positioning is safe because oxygenation improved. Adverse events occurred in 84.9% of sessions, facial pressure ulcers affected 38.1% of patients, and the study had no non-prone control group.