Preventing Pressure Injuries From Prone Positioning in Ventilated Patients

Can a certified wound and skin care nurse prevent pressure injuries in patients with COVID and ARDS receiving ventilation in the prone position?

For patients with acute respiratory distress syndrome (ARDS) and COVID-19, provision of care via a multi-professional prone-positioning team that included a certified wound and skin care nurse significantly reduced the odds of pressure injuries developing in those patients, according to research findings published recently in the American Journal of Critical Care.

Patients presenting with ARDS are often placed prone to improve oxygenation and reduce mortality risk, but doing so also increases the patient’s risk for pressure injuries. Researchers sought to determine whether having a certified wound and skin care nurse lead the pressure-injury prevention component of the prone-positioning protocol would reduce pressure injuries.

The multi-center observational cohort study, which used retrospective data, included patients at least 21 years of age who were admitted to the critical care units of the Penn Medicine Health System in the US mid-Atlantic region. All patients in the study were intubated, diagnosed with ARDS, and infected with SARS-CoV-2, and all were treated by a multidisciplinary prone-positioning team.

Of the130 patients included in the study, 52 were in the intervention group (median age 63, IQR 56-69; 25% female) and 78 were in the comparison group (median age 60, IQR 51-67; 37% female). In the intervention group, the prone positioning team included a certified wound and skin care nurse to address pressure injuries, whereas the control group’s team did not.

Using multivariable logistic regression mixed-effect modeling to adjust for the effects of race/ethnicity, discharge status, comorbidities, length of stay, and type of bed used by the patients in the 2 groups, researchers found that patients in the intervention group had a 97% lower adjusted odds ratio of a pressure injury developing than did patients in the comparison group (adjusted odds ratio 0.03 [95% CI, 0.01-0.14]; P <.001).

According to researchers, “the active presence of a certified and specialized nurse with expertise in pressure injury prevention and skin preservation significantly reduced the odds of patients having pressure injuries develop when they were placed prone for prolonged periods.”


Johnson C, Giordano NA, Patel L, et al. Pressure injury outcomes of a prone-positioning protocol in patients with COVID and ARDS. Am J Crit Care. 2022;31(1):34-41. doi:10.4037/ajcc2022242

This article originally appeared on Pulmonology Advisor