(EBP-010) The impact of prone positioning on the incidence of pressure injuries in adult intensive care unit patients

Co-Author(s):

Zena Moore, PhD – Professor, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences; Tom O'Connor, PhD – Professor, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences

Introduction:

Intensive care unit patients experience more pressure injuries (PI) than the general hospital population. Although prone positioning is beneficial for respiratory function, it often leads to PIs on weight bearing areas of the body. Numerous systematic reviews have examined the impact of prone positioning on outcomes, including PI.

Methods: This meta-review appraised existing systematic reviews that measured the incidence and prevalence of prone position induced PIs in adult ICU patients. The team followed the standard approach advocated for systematic reviews and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to guide the conduct and reporting of the meta-review.

Results: Ten systematic reviews were synthesised. The cumulative incidence of PI in 15,979 adult patients ranged from 25.7% to 48.5%. One study did not report adult numbers. Only one review reported the secondary outcome of PI location. PIs were identified in 13 locations such as the face, chest, iliac crest, and knees. Using the AMSTAR-2, three reviews were assessed as high quality, six as moderate quality, and one as low quality.

Discussion: The high incidence of PI in the prone position highlights the need for targeted preventative strategies, with the necessity that nurses are educated on and know what these are. Education on existing care bundles may be one approach, given their beneficial effects for the prevention of PI in other populations.

Trademarked Items:

References: 1. Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev 2015;2015. https://doi.org/10.1002/ 14651858.CD008095.pub2. Cd008095. 2015/11/13.

2. Munshi L, Del Sorbo L, Adhikari NKJ, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Annals of the American Thoracic Society 2017;14:S280e8. https://doi.org/10.1513/AnnalsATS.201704-343OT. 2017/10/27.

3. Sud S, Friedrich JO, Adhikari NK, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2014;186: E381e90. https://doi.org/10.1503/cmaj.140081. Canadian Medical Association journal ¼ journal de l'Association medicale canadienne 2014/05/28.