Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study)

Anika Fourie, Maarit Ahtiala, Joyce Black, Heidi Hevia, Fiona Coyer, Amit Gefen, Kim LeBlanc, Steven Smet, Kathleen Vollman, Yolanda Walsh, Dimitri Beeckman, Anika Fourie, Maarit Ahtiala, Joyce Black, Heidi Hevia, Fiona Coyer, Amit Gefen, Kim LeBlanc, Steven Smet, Kathleen Vollman, Yolanda Walsh, Dimitri Beeckman

Abstract

Background: Ventilating critically ill patients with acute respiratory distress syndrome in the prone position is a life-saving strategy, but it is associated with adverse consequences such as skin damage.

Aim: To identify, review and evaluate international proning and skin care guidelines and make an inventory of commonly used equipment and training resources.

Design: A gap analysis methodology was applied.

Methods: 1) Comprehensive search and evaluation of proning and skin care guidelines, 2) extensive search and listing equipment and educational resources, and 3) international consultation with 11 experts (8 countries).

Data sources: A variety of sources researched through July 2021 were used to identify relevant literature: (1) scientific literature databases and clinical trials registries, (2) intensive care and wound care associations, (3) healthcare organisations, (4) guideline development organisations, and (5) the Google search engine. Eleven international experts reviewed the literature and provided insights in two, 2-h online sessions.

Findings: The search yielded 24 guidelines. One clinical practice guideline had high methodological quality. Twenty-five devices/equipment and sixteen teaching materials were identified and discussed with the expert panel. The gap analysis identified a lack of concise, accessible, evidence-based guidelines and educational materials of short duration.

Conclusion: This analysis forms the basis for designing a competency-based education and training intervention for an interdisciplinary team caring for the skin of critically ill patients in the prone position.

Impact: The results can assist the multidisciplinary team to review their current protocol for prone positioning. This is a first step in developing a training package for clinicians.

Keywords: COVID-19; Critical care; Pressure ulcer; Prone position; Respiratory distress syndrome; Skin damage.

Conflict of interest statement

Authors AF, DB, AG, SS, YW, HHC, FC, KL have no competing interests to declare.

JB declared being a consultant and speaker for Mölnlycke, Sage: A Division of Stryker, and Mobility is Medicine.

KV declared being a consultant and speaker for Sage: A Division of Stryker and Mobility is Medicine.

MA declared being a speaker for Mölnlycke.

Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow diagram for study selection of records containing guidance regarding skin damage prevention during prone positioning. Abbreviation: PP = prone position.

References

    1. Mosby's Medical . Nursing & allied health dictionary. sixth ed. Mosby Inc; St Lois, Missouri: 2002.
    1. Ranieri V.M., Rubenfeld G.D., Thompson B.T., et al. ARDS definition task force. Acute respiratory distress syndrome: the berlin definition. J Am Med Assoc. 2012;307:2526–2533. doi: 10.1001/jama.2012.5669.
    1. Piehl M.A., Brown R.S. Use of extreme position changes in acute respiratory failure. Crit Care Med. 1976;4:13–14.
    1. Guérin C., Reignier J., Richard J.C., et al. PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–2168. doi: 10.1056/NEJMoa1214103.
    1. Scholten E.L., Beitler J.R., Prisk G.K., Malhotra A. Treatment of ARDS with prone positioning. Chest. 2017;151:215–224. doi: 10.1016/j.chest.2016.06.032.
    1. Sud S., Friedrich J.O., Adhikari N.K., 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 (Can Med Assoc J) 2014;186:E381–E390. doi: 10.1503/cmaj.140081.
    1. Li Q., Guan X., Wu P., et al. Early transmission dynamics in wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–1207. doi: 10.1056/NEJMoa2001316.
    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5.
    1. Lee J.M., Bae W., Lee Y.J., Cho Y.J. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med. 2014;42:1252–1262. doi: 10.1097/CCM.0000000000000122.
    1. Mora-Arteaga J., Bernal-Ramirez O., Rodriguez S. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med. Intensiva (English Edition) 2015;39:359–372. doi: 10.1016/j.medine.2014.11.004.
    1. Munshi L., Del Sorbo L., Adhikari N.K.J., et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14:S280–s288. doi: 10.1513/AnnalsATS.201704-343OT.
    1. Gattinoni L., Tognoni G., Pesenti A., et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345:568–573. doi: 10.1056/NEJMoa010043.
    1. Chan M.C., Hsu J.Y., Liu H.H., et al. Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc. 2007;106:708–716. doi: 10.1016/S0929-6646(08)60032-7.
    1. Gefen A., Creehan S., Black J. Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: a scoping review. Int Wound J. 2020;17:1405–1423. doi: 10.1111/iwj.13408.
    1. Shearer S.C., Parsa K.M., Newark A., Peesay T., Walsh A.R., Fernandez S., et al. Facial pressure injuries from prone positioning in the COVID-19 era. Laryngoscope. 2021;131(7) E2139-e42.
    1. Challoner T., Vesel T., Dosanjh A., Kok K. The risk of pressure ulcers in a proned COVID population. Surgeon. 2021 doi: 10.1016/j.surge.2021.07.001. In press.
    1. Peko L., Barakat-Johnson M., Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: a timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J. 2020;17:1595–1606. doi: 10.1111/iwj.13435.
    1. Clay A.S., Chudgar S.M., Turner K.M., Vaughn J., Knudsen N.W., Farnan J.M., et al. How prepared are medical and nursing students to identify common hazards in the intensive care unit? Ann Am Thorac Soc. 2017;14(4):543–549. doi: 10.1513/AnnalsATS.201610-773OC.
    1. Gaspar S., Botelho Guedes F., Vitoriano Budri A.M., Ferreira C., Gaspar de Matos M. Hospital-acquired pressure ulcers prevention: what is needed for patient safety? The perceptions of nurse stakeholders. Scand JCaring Sci. 2021;00:1–10. doi: 10.1111/scs.12995.
    1. Golden S.H., Hager D., Gould L.J., Mathioudakis N., Pronovost P.J. A gap analysis needs assessment tool to drive a care delivery and research agenda for integration of care and sharing of best practices across a health system. Joint Comm J Qual Patient Saf. 2017;43:18–28. doi: 10.1016/j.jcjq.2016.10.004.
    1. Brouwers M.C., Kerkvliet K., Spithoff K. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ. 2016;352:i1152. doi: 10.1136/bmj.i1152.
    1. Guidance For: prone positioning in adult critical care. Faculty of Intensive Care Medicine and Intensive Care Society; November 2019. [Available from:prone_position_in_adult_critical_care_2019.pdf ()
    1. Douglas I.S., Rosenthal C.A., Swanson D.D., Hiller T., Oakes J., Bach J., et al. Safety and outcomes of prolonged usual care prone position mechanical ventilation to treat acute coronavirus disease 2019 hypoxemic respiratory failure*. Crit Care Med. 2021;49(3):490–502. doi: 10.1097/CCM.0000000000004818.
    1. Klaiman T., Silvestri J.S., Srinivasan T., Szymanski S., Tran T., Oredeka F., et al. Improving prone positioning for severe acute respiratory distress syndrome during the COVID-19 pandemic. An implementation-mapping approach. Ann Am Thorac Soc. 2021;18(2):300–307. doi: 10.1513/AnnalsATS.202005-571OC.
    1. Miguel K., Snydeman C., Capasso V., Walsh M.A., Murphy J., Wang X.S. Development of a prone team and exploration of staff perceptions during COVID-19. AACN Adv Crit Care. 2021;32(2):159–168. doi: 10.4037/aacnacc2021848.
    1. Mitchell, Seckel . vol. 29. 2018. pp. 415–425. (AACN advanced critical care). Available at. 4.
    1. Montanaro J. Using in situ simulation to develop a prone positioning protocol for patients with ARDS. Crit Care Nurse. 2021;41(1):12–24. doi: 10.4037/ccn2020830.
    1. Oliveira V.M., Weschenfelder M.E., Deponti G., Condessa R., Loss H.S., Barrios P.M., et al. Good practices for prone positioning at the bedside: construction of a care protocol. Rev Assoc Med Bras. 2016;62(3):287–293. doi: 10.1590/1806-9282.62.03.287.
    1. Santos V.B., Aprile D., Lopes C.T., Lopes J.L., Gamba M.A., Costa K., et al. COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention. Rev Bras Enferm. 2021. 2021;74(Suppl 1) doi: 10.1590/0034-7167-2020-1185.
    1. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The international guideline. Emily haesler. EPUAP/NPIAP/PPPIA; 2019. European pressure ulcer advisory Panel, national pressure injury advisory Panel and Pan pacific pressure injury alliance.
    1. Capasso V., Snydeman C., Miguel K., Wang X., Crocker M., Chornoby Z., et al. Pressure injury development, mitigation, and outcomes of patients proned for acute respiratory distress syndrome. Adv Skin Wound Care. 2021 doi: 10.1097/01.ASW.0000767404.02594.85. online ahead of print.
    1. Peko L., Barakat-Johnson M., Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: a timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J. 2020;17:1595–1606. doi: 10.1111/iwj.13435.
    1. Ibarra G., Rivera A., Fernandez-Ibarburu B., Lorca-Garcia C., Garcia-Ruano A. Prone position pressure sores in the COVID-19 pandemic: the Madrid experience. J Plast Reconstr Aesthetic Surg. 2020 Dec 26:S1748–S6815. doi: 10.1016/j.bjps.2020.12.057. (20)30732-4. [Online ahead of print]
    1. Mobility is Medicine Proning safely: pressure injury prevention. 2020, May 21. [Video]. YouTube.
    1. Rush University System for Health Prone positioning for patients with acute respiratory distress syndrome (ARDS) 2020, April 2. [Video]. YouTube.
    1. Adewole D.A., Salawu M.M., Bello S. Training needs assessment and preferred approach to enhancing work performance among clinical nurses in University College Hospital (UCH), Ibadan, Oyo State, South-western Nigeria. IJNM. 2020;12:130–138. doi: 10.5897/IJNM2020.0434.

Source: PubMed

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