Prevention of Hospital-Acquired Pressure Injury in COVID-19 Patients in the Prone Position

Prone, also referred as face-down, position is frequently used as adjuvant therapy to improve lung mechanics and gas exchange in patients with acute respiratory distress syndrome (ARDS) admitted to an intensive care unit (ICU) and ventilated mechanically. Findings of the recently updated Cochrane review (Bloomfield et al., 2015) indicated there is weak evidence of the benefit for application of ventilation in the prone position to all patients with hypoxaemia recruited in randomised controlled trials; although stronger evidence of benefit is reported for the subgroups of patients with severe hypoxaemia, who started treatment earlier and stayed in ICU longer. The use of prone positioning in the ICU has re-emerged with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected patients with ARDS. Prone positioning is widely used in the management of the ARDS syndrome, both in non-intubated and mechanically ventilated COVID-19 patients (Behesht Aeen et al., 2021), although the effectiveness of prone positioning is debatable.