Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS-CoV-2 pulmonary infection

Background: Because of the coronavirus disease 2019 (COVID-19) pandemic, the use of prone positioning has dramatically increased in the intensive care unit (ICU). Because this manoeuvre is related to several complications, it must be performed in a protocolized manner by the appropriate personnel. Aim: To determine the prevalence of adverse events (AEs) in patients admitted to the ICU with a diagnosis of COVID-19-related acute respiratory distress syndrome (C-ARDS) undergoing mechanical ventilation in prone position (PP). Design: Descriptive ambispective study of patients admitted to the ICU diagnosed with C-ARDS undergoing mechanical ventilation who were in the PP at least once. The number of PP manoeuvres and the time spent in the PP were recorded for each subject. AEs proportions and frequencies were calculated, and analysis of variance was used to assess mean differences in the number of manoeuvres and total hours in PP stratified by the number of facial pressure ulcers. IBM SPSS Statistics v.25.0. and EPIDAT 4.1 software were used. Results: Forty-four patients were analysed, and 130 PP manoeuvres were performed. The most frequently observed AEs were facial oedema in 26 patients (80.3%) and facial pressure ulcers in 20 (60.6%). There was a significant positive association between the time spent in PP and the development of facial pressure ulcers (P <.001). Enteral nutrition was well tolerated, and no serious AEs or sentinel events were noted. Conclusion: Despite the stressful, demanding situation during the peak of the pandemic, the large number of PP manoeuvres, and long duration spent in this position, no serious AEs occurred. This study highlights the need to implement preventive measures to avoid the development of pressure ulcers secondary to prone positioning. Relevance to practice: Prone positioning requires a nursing protocol to prevent the occurrence of AEs that may reduce the quality of nursing care.