Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome.

Capasso, Virginia; Snydeman, Colleen; Miguel, Karen; Wang, Xianghong; Crocker, Michelle; Chornoby, Zachary; Vangel, Mark; Walsh, Mary Ann; Murphy, John; Qualls, Stephanie

OBJECTIVE To describe trends and risk factors for pressure injuries (PI) in adult critical care patients placed in prone position between April 9, 2020 and June 8, 2020 to alleviate acute respiratory distress syndrome (ARDS) secondary to COVID-19 and examine effectiveness of products and strategies to mitigate PIs. METHODS A retrospective chart review was conducted. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed using t-tests, X2 and Fisher's exact tests, and Cox regression analysis. RESULTS Among 147 patients, significant PI risk factors included male sex (P = .019), high BMI (>40 kg/m2; P = .020), low Braden score (<12; P = .018), and low-dose vasopressor therapy (P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders (P < .0001). Maximum prone duration/session was significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. D-Dimer over 3,200 ug/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. The mortality was 34%; significant risk factors included age over 60 years (P = .005), Sequential Organ Failure Assessment score over 11 (P = .003), and comorbid congestive heart failure (P = .016). CONCLUSIONS This study illustrates extrinsic and intrinsic risk factors for PIs. Taping the ETT versus using a commercial ETT holder, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing the effectiveness of pressure redistribution products for PI prevention will inform product selection and individualized patient care.