Document Type
Article
Publication Date
9-2024
Publisher
Lippincott, Williams & Wilkins
Source Publication
Dimensions of Critical Care Nursing
Source ISSN
0730-4625
Original Item ID
10.1097/DCC.0000000000000654
Abstract
Background
Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs).
Objectives
To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest.
Method
This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression.
Results
The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure–adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03)
Discussion
Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.
Recommended Citation
Hlebichuk, Jeanne; Buck, Elissa; Brooker, Angeline L.; Mackenzie, Julie K.; and Singh, Maharaj, "Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries" (2024). College of Nursing Faculty Research and Publications. 1308.
https://epublications.marquette.edu/nursing_fac/1308
Comments
Accepted version. Dimensions of Critical Care Nursing, Vol. 45, No. 5 (September/October 2024): 246-252. DOI. © 2024 Wolters Kluwer Health, Inc. Used with permission.