Effect of comprehensive pressure ulcer prevention measures on critically ill patients with coronavirus disease 2019 undergoing prolonged prone positioning during mechanical ventilation: A retrospective observational study

Objective: We examined the effect of comprehensive pressure ulcer prevention measures and identified the risk factors of pressure ulcer development in critically ill patients with coronavirus disease 2019（COVID-19）undergoing prolonged prone positioning during mechanical ventilation. <br>　Methods: This retrospective observational study included patients with COVID-19 who received mechanical ventilation with prone positioning >16 h per day. To examine the effect of the comprehensive measures, we compared the effects of the first intervention, consisting of the use of a dry polymer pad on the face and pressure redistribution urethane foam on the contact areas on the skin with those of the second intervention, consisting of the addition of a protective helmet system on the face and low-resilience elastic urethane foam on the anterior chest wall. Additionally, patients were compared in terms of the presence or absence of pressure ulcers to determine the risk factors of pressure ulcer development. <br>　　Results: The first and second intervention groups included eight patients each; the pressure ulcer incidence during their intensive care unit（ICU）stay was 75% and 50%, respectively. The pressure ulcer sites after the first and second interventions included the zygomatic bone（3 vs 5 cases）, jaw（2 vs 0 cases）, sacrum（1 vs 1 case）, and heel（0 vs 0 cases）. Patients with pressure ulcers had a higher maximum Sequential Organ Failure Assessment（SOFA）score during their ICU stay（median: 19.5 vs 14.0; p=0.03）. <br>　Conclusions: The comprehensive measures examined did not reduce the facial pressure ulcer incidence. A high maximum SOFA score during the patients’ ICU stay may be a risk factor of pressure ulcer development.