Alberto Lucchini1, Stefano Bambi, Elisa Mattiussi, Stefano Elli, Laura Villa, Herman Bondi, Roberto Rona, Roberto Fumagalli, Giuseppe Foti. 1. Alberto Lucchini, RN, is head nurse at the General Intensive Care Unit, ASST Monza, San Gerardo Hospital, Italy. He is the coordinator of the master's degree program in intensive and critical care nursing at Milano-Bicocca University, Italy. Stefano Bambi, PhD, MSc, RN, CCN, is a staff nurse at the Medical & Surgical Intensive Care Unit, Careggi Teaching Hospital, Florence, Italy. He was formerly a lecturer in emergency and critical care nursing at University of Florence (Italy). Elisa Mattiussi, MSc, RN, CCN, is a professor-in-charge at School of Nursing, Department of Medical and Biological Sciences, Udine University, Italy. Stefano Elli, RN, is currently employed at the General Intensive Care Unit, Emergency Department, San Gerardo Hospital, and University of Milan-Bicocca, Italy. Laura Villa, RN, CCN, is a staff nurse at General Intensive Care Unit, ASST Monza, San Gerardo Hospital. Herman Bondi, RN, CCN, is a staff nurse at General Intensive Care Unit, ASST Monza, San Gerardo Hospital. Roberto Rona, MD, is director of general intensive care unit, ASST Monza, San Gerardo Hospital. Roberto Fumagalli, MD, is director and a full professor at Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital, University of Milan-Bicocca, Milan, Italy. Giuseppe Foti, MD, is director and an associate professor at the Emergency Department, ASST Monza, San Gerardo Hospital.
Abstract
BACKGROUND: Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise. AIMS: The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS. DESIGN: This is a single-center, retrospective, observational study. RESULTS: One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed. CONCLUSIONS: The onset rate of complications given by the use of prone position in ARDS patients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.
BACKGROUND: Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise. AIMS: The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS. DESIGN: This is a single-center, retrospective, observational study. RESULTS: One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed. CONCLUSIONS: The onset rate of complications given by the use of prone position in ARDSpatients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.
Authors: María Dolores Rodríguez-Huerta; Ana Díez-Fernández; María Jesús Rodríguez-Alonso; María Robles-González; María Martín-Rodríguez; Alberto González-García Journal: Nurs Crit Care Date: 2021-03-16 Impact factor: 2.897
Authors: Claude Guérin; Richard K Albert; Jeremy Beitler; Luciano Gattinoni; Samir Jaber; John J Marini; Laveena Munshi; Laurent Papazian; Antonio Pesenti; Antoine Vieillard-Baron; Jordi Mancebo Journal: Intensive Care Med Date: 2020-11-10 Impact factor: 41.787