Comparison of the Prone Position-related Characteristics of Intubated COVID-19 Patients with and without Facial Pressure Injuries

Background: In Coronavirus 2019 (COVID-19) patients, the risk of a facial pressure injury increases due to the prolonged prone position.

Aim: To compare the prone position-related characteristics of intubated COVID-19 patients with and without facial pressure injuries.

Methods: This cross-sectional, retrospective, and case–control study included 49 COVID-19 patients who were intubated and in the prone position in the adult intensive care unit of Koç University Hospital between March 01, 2020, and March 15, 2021. Retrospective data of the patients were obtained using the Patient Information Form. While evaluating the demographic and clinical data, descriptive statistical methods (frequency, percentage, mean, and standard deviation) were used. Furthermore, for the comparison of the prone position-related features (day of onset, frequency, and total duration) between patients with and without facial pressure injuries, the Mann–Whitney U test was used.

Results: It was determined that 52.1% of the intubated patients required a prone position, and 73.4% developed facial pressure injuries after prone positioning. Pressure injury developed on the 7th day of the prone position and on the chin (29%), left cheek (20.5%), nose (17.9%), and right cheek (16.7%), respectively. The prone duration was statistically significantly higher in patients with facial pressure injuries than those without (P <.01).

Conclusions: Pressure injuries occur with a high incidence in intubated COVID-19 patients in the prone position. Importance should be given to maintaining the treatment and care approaches with the multidisciplinary team for patients who still require prolonged prone positioning despite the development of pressure injuries in the facial area. Focusing primarily on preventing pressure injuries in the face area with frequent skin preparations and more frequent head position changes in the early period may contribute to prevention. In addition, there is a need for different and more preventive-oriented measures and specific protocols specific to COVID-19 patients in prolonged prone positions.