Prone position pressure sores in the COVID-19 pandemic: The Madrid experience

Ibarra, Gorka; Rivera, Antonio; Fernández-Ibarburu, Borja; Lorca-García, Concepción; García-Ruano, Ángela

doi:10.1016/j.bjps.2020.12.057

Cited by 80 publications

(122 citation statements)

References 24 publications

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“…The swimming position was reported in seven (53.8%) recommendations but was performed in only three (10.7%) original studies, whereas the complete prone positioning (180º) was mentioned in only one recommendation but was performed in seven (25.0%) studies. Although the PROSEVA trial used complete prone positioning with arms placed alongside the body, we also observed a trend in the recommendation of the swimming position; however, there is heterogeneity in its description, with the majority of documents describing it as placing the face towards the abducted and flexed arm 29,30,54 , whereas others describe it as placing the face towards the straight arm 55 . Currently, there is no completely safe and suitable positioning of the body that will ensure the minimization of nerve injury in every patient, but some authors promote an understanding of the principles of a safe position and encourage the maintenance of a high clinical suspicion of potential brachial plexus injury during the prone position, especially for unconscious and paralyzed patients 54 .…”

Section: Discussionmentioning

confidence: 84%

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

et al. 2021

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INTRODUCTION: Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in acute respiratory distress syndrome (ARDS), particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. While the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events related to prone positioning in ARDS, and secondarily, to collect strategies and recommendations to mitigate these adverse events. METHODS: In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from six relevant electronic databases and the websites of intensive care societies. RESULTS: We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 patients and 994 prone maneuvers). We identified more than 40 individual adverse events, and the highest pooled occurrence rates were that of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilationassociated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning include alternate face rotation (18 [43.9%]), repositioning every 2 hours (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprise one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]). CONCLUSIONS: We identified >40 adverse events reported in prone positioning ARDS studies, involving additional AEs not yet reported by previous systematic reviews. The Page 3 of 43 Respiratory Care 4 pooled adverse event proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate adverse events could promote future consensus-based recommendations.

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Section: Discussionmentioning

confidence: 84%

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

et al. 2021

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“…This practice recommendation requires a close collaboration between intensivists, anaesthesiologists, nurses, dermatologists, and dentists to monitor and manage the pressure ulcers at an early stage. Overloaded healthcare systems for the long-term by COVID-19 might be one of the reasons for the high prevalence of perioral pressure ulcers as in many countries less experienced healthcare staff might be present in the ICU as retrieved by our literature review [22,29].…”

Section: Discussionmentioning

confidence: 99%

“…On reviewing the emerging evidence on ICU-related complications in COVID-19 patients, fourteen studies (one cohort study [20], two case-control studies [21,22], one cross-sectional study [23], two case-series [24,25], and eight case-reports [26][27][28][29][30][31][32][33]) with two hundred ten patients met the inclusion criteria. The majority of the cases were from the Americas (USA n = 103, 49.5%; Brazil n = 4, 1.9%), followed by Europe (Spain n = 57, 27.1%; UK n = 16, 7.6%; France n = 2, 1%; and Italy n = 2, 1%), and Middle East (Iran n = 26, 12.4%).…”

Section: Literature Reviewmentioning

confidence: 99%

“…The perioral (facial) pressure ulcers have been the most prevalent ICU-related oral complication in COVID-19 patients reported by ten studies in one hundred seventy-nine patients; 73.75% of them were males, and the vast majority were of old age [20][21][22][23]25,[29][30][31][32][33]. Prolonged pronation and endotracheal intubation were the most evident risk factors for perioral pressure ulcers.…”

Section: Perioral Pressure Ulcers (Icd-11: Eh90)mentioning

confidence: 99%

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Oral Complications of ICU Patients with COVID-19: Case-Series and Review of Two Hundred Ten Cases

Hocková

Riad

Války³

et al. 2021

JCM

124

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Background: The critically ill patients suffering from coronavirus disease (COVID-19) and admitted to the intensive care units (ICUs) are susceptible to a wide array of complications that can be life-threatening or impose them to long-term complications. The COVID-19 oral mucocutaneous complications require multidisciplinary management and research for their pathophysiological course and epidemiological significance; therefore, the objective of this study was to evaluate the prevalence and characteristics of the critically ill COVID-19 patients with oral complications. Methods: We described the clinical and microbiological characteristics of the critically ill COVID-19 patients in our ICU department (Banska Bystrica, Slovakia). In addition, we reviewed the current body of evidence in Ovid MEDLINE®, Embase, Cochrane Library, and Google Scholar for the oral mucocutaneous complications of ICU patients with COVID-19. Results: Three out of nine critically ill patients (33.3%) in our ICU department presented with oral complications including haemorrhagic ulcers and necrotic ulcers affecting the lips and tongue. The microbiological assessment revealed the presence of opportunistic pathogens, confirming the possibility of co-infection. On reviewing the current literature, two hundred ten critically ill patients were reported to have oral complications due to their stay in the ICU setting. Perioral pressure ulcers were the most common complication, followed by oral candidiasis, herpetic and haemorrhagic ulcers, and acute onset macroglossia. The prolonged prone positioning and mechanical ventilation devices were the primary risk factors for those oral complications, in addition to the immunosuppressive drugs. Conclusions: The multidisciplinary approach is strongly advocated for monitoring and management of COVID-19 patients, thus implying that dermatology and oral healthcare specialists and nurses should be integrated within the ICU teams.

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“…Facial pressure ulcers occur mostly at the level of the bony structures, including the chin and the cheekbone. 2 …”

mentioning

confidence: 99%