Modified Versus Conventional Prone Position for COVID-19 Patients in Adult Intensive Care Units: A Comparative Study.

Background: Prone position has been reported to improve prognosis and reduce mortality in COVID-19 patients, but poor patient tolerance and complications remain an issue.

Aim: This study aimed to compare the modified vs. conventional prone position on pressure injuries in COVID-19 patients in adult intensive care units (ICU).

Study design: This retrospective comparative study enrolled COVID-19-positive patients who were admitted to the emergency adult ICU of a tertiary general hospital between December 2022 and January 2023. All data were extracted from patient charts. The primary outcome was pressure injury. During the study period, pressure injuries were evaluated using the staging system of the International Clinical Practice Guideline for the prevention and treatment of pressure injuries in 2019.

Results: A total of 39 COVID-19-positive patients (16 females) were included, and 19 patients received the modified prone position. Compared to those with the conventional prone position, patients with the modified prone position had significantly lower occurrence of pressure injury (3 (25.0%) vs. 9 (75.0%), p = 0.044), eyelid oedema (2 (10.5%) vs. 9 (45.0%), p = 0.031) and facial oedema (5 (26.3%) vs. 13 (65%), p = 0.024) and significantly higher daily continuous prone position time (9.16 ± 3.01 vs. 6.50 ± 2.14, p = 0.003). The occurrence site and stage of pressure injury, transcutaneous blood oxygen saturation, airway adverse events and brachial plexus injury were comparable between the groups (all p > 0.05).

Conclusion: Compared to the conventional prone position, the modified prone position may significantly reduce the occurrence of pressure injuries and improve patient tolerance in COVID-19 patients in the adult ICU.

Relevance to clinical practice: These findings provide guidance for critical care nurses to implement prone positioning interventions.