Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study.

ARDS COVID-19 Complications Pressure Injuries Prone positioning

Journal

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852

Informations de publication

Date de publication:
14 Oct 2024
Historique:
received: 05 05 2024
revised: 16 08 2024
accepted: 05 09 2024
medline: 16 10 2024
pubmed: 16 10 2024
entrez: 15 10 2024
Statut: aheadofprint

Résumé

Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS. Multicentre, retrospective observational study. Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected. We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported. Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.
DESIGN METHODS
Multicentre, retrospective observational study.
METHODS METHODS
Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected.
RESULTS RESULTS
We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported.
CONCLUSIONS CONCLUSIONS
Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.

Identifiants

DOI: 10.1016/j.aucc.2024.09.002 PMID: 39406618
pubmed: 39406618
pii: S1036-7314(24)00254-6
doi: 10.1016/j.aucc.2024.09.002
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101117

Informations de copyright

Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Auteurs

Thomas C Rollinson (TC)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia. Electronic address: thomas.rollinson@austin.org.au.

Luke A McDonald (LA)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.

Joleen Rose (J)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.

Glenn Eastwood (G)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Rahul Costa-Pinto (R)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.

Lucy Modra (L)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.

Maeda Akinori (M)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.

Zoe Bacolas (Z)

Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.

James Anstey (J)

Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Samantha Bates (S)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.

Scott Bradley (S)

Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia.

Jodi Dumbrell (J)

Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Craig French (C)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.

Angaj Ghosh (A)

Department of Intensive Care, Northern Health, VIC, Australia.

Kimberley Haines (K)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia.

Tim Haydon (T)

Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.

Carol L Hodgson (CL)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Jennifer Holmes (J)

Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.

Nina Leggett (N)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia.

Forbes McGain (F)

Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.

Cara Moore (C)

Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Kathleen Nelson (K)

Department of Physiotherapy, Alfred Health, VIC, Australia.

Jeffrey Presneill (J)

Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Hannah Rotherham (H)

Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Simone Said (S)

Department of Intensive Care, Northern Health, VIC, Australia.

Meredith Young (M)

Department of Intensive Care, Alfred Health, VIC, Australia.

Peinan Zhao (P)

Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Andrew Udy (A)

Department of Intensive Care, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Ary Serpa Neto (A)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Anis Chaba (A)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.

Rinaldo Bellomo (R)

Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

Classifications MeSH