Clinical Practice Guidelines for the Prevention and Management of Pressure Injury in Critically Ill Patients Undergoing Prone Position Ventilation: A Systematic Review.

Abstract

Significance: This systematic review was conducted to assess the quality of clinical practice guidelines (CPGs) on prevention and management of pressure injury (PI) in patients undergoing prone position ventilation (PPV) and summarize the recommendations based on the analyses of the CPGs. Recent Advances: We searched the PubMed, Cochrane library, Embase databases, guideline websites, professional association, quality standards, and Wound-Related Research Journals from January 1, 2010 to August 31, 2024. Included guidelines were those with recommendations for prevention and management of PI in patients undergoing PPV published in English. Four researchers independently assessed the eligible studies and extracted the data. Appraisal of Guidelines Research & Evaluation (AGREE II) instrument and the Reporting Items for Practice Guidelines in Healthcare checklist were used to assess the quality of the CPGs. Critical Issues: A total of 13 CPGs were included in this review. AGREE II demonstrated that the highest mean score was based on the scope and purpose and was 73.65 ± 10.91, whereas the lowest mean score was based on the editorial independence and was 49.79 ± 19.49. The scores of inter-rater agreements for AGREE-II quality appraisal ranged from 0.86 to 0.96. Recommendations for prevention and management of PI in patients undergoing PPV were inconsistent. Future Directions: The included CPGs were limited due to methodological issues and exhibited discrepancies in the coverage of important topics. Therefore, existing evidence should be used to propose identifiable recommendations and strengthen the rigor and standardization of guideline development in future research.