Keywords

acute respiratory distress syndrome, coronavirus, COVID-19, endotracheal tube, pressure injury, prone positioning

Authors

1. Capasso, Virginia PhD, CNP, ACNS-BC, CWS, FACCWS, FAAN
2. Snydeman, Colleen PhD, RN
3. Miguel, Karen MM-H, RN
4. Wang, Xianghong MS
5. Crocker, Michelle BSN, RN
6. Chornoby, Zachary BSN, RN, CCRN
7. Vangel, Mark PhD
8. Walsh, Mary Ann BSN, RN
9. Murphy, John DNP, RN
10. Qualls, Stephanie MSN, RN

ABSTRACT

OBJECTIVE: To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs.

METHODS: The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed.

RESULTS: Among 147 patients, significant PI risk factors included male sex (P = .019), high body mass index (>40 kg/m²; P = .020), low Braden Scale 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 a significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. D-Dimer greater than 3,200 [mu]g/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 (P = .003), and comorbid congestive heart failure (P = .016).

CONCLUSIONS: Taping the ETT, 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 products for PI prevention will inform individualized patient care.