Complications of prone positioning in patients with COVID-19: A cross-sectional study

Abstract

Objective To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. Methods Cross-sectional study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if none unplanned extubation was recorded. Bleeding of upper airways represented the most common site (17.5%). Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04 to 3.6). Conclusion The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.

Time to active sitting position: One-year findings from a temporary COVID-19 intensive care unit

“…Finally, very few serious AEs occurred during physiotherapy. Despite oxygen desaturation, which is described as a common finding during physiotherapy [ 44 ] and prone positioning [ 45 ] in patients with COVID-19, accidental device removals were reported in five individuals only (1.8%, 5/284), adding to literature that early mobilization is generally safe and within expected frequency [ 46 ].…”

Masseter muscle pressure injury: First report of a prone position complication in patients with COVID-19

“…To date, numerous PP complications in patients with COVID-19 have been reported. Among them are mainly described facial pressure injuries involving skin and ocular surface ( Binda et al, 2021 , Sanghi et al, 2021 , Perrillat et al, 2020 ) with their potential sequelae ( Schols et al, 2021 ). However, only few descriptions of such proning complication involving facial deep tissues are reported in literature ( Perrillat et al, 2020 , Abbal et al, 2012 ).…”

“…As an adjuvant to mechanical ventilation, prone positioning (PP) is an effective treatment for acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 severe infection ( Shelhamer et al, 2021 ). Numerous PP side effects have already been described ( Binda et al, 2021 , Bruni et al, 2021 ). They usually result in a soft tissues compression.…”

Proning: All things matter

“…Patients with severe Covid-19 requiring oxygen therapy are also on the rise. Prone ventilation in both awake and intubated patients with severe Covid-19 has been proven to improve oxygenation [1], even though adverse events related to proning are not uncommon among intubated patients [2,3]. Thus, it is necessary to carefully consider patient factors prior to choosing this rescue method.…”

“…Proning has led to complications, especially in mechanically ventilated Covid-19 patients. These include an increased incidence of pressure ulcers, airway related bleeding, medical device related issues [3] and peripheral nerve injuries [2]. Proning invariably affects almost all the body systems in the body which may be detrimental at times.…”