Lateral positioning for critically ill adult patients

Hewitt, Nicky; Bucknall, Tracey; Glanville, D

doi:10.1002/14651858.cd007205

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…A Cochrane review reveals that the routine use of this technique at an angle varying from 20° to 90° has contributed to PI prevention in critical care units. (Hewitt et al, 2016). Despite the lack of studies that provided a detailed description of the techniques used for repositioning critically ill patients, the international recommendations are to maintain between 15°–30° in repositioning, taking into account the achievement of the offloading principle (EPUAP, NPIAP, & PPPIA, 2019).…”

Section: Discussionmentioning

confidence: 99%

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

Alshahrani

Sim

Middleton

2021

Journal of Clinical Nursing

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Aim To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. Background Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital‐acquired pressure injuries continue to occur in these settings. Design A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) and Synthesis without meta‐analysis (SWiM) guidelines. Methods Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis. Results The review included 14 studies. Randomised controlled trials, quasi‐experimental, case series and cross‐sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device‐related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low. Conclusions Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence‐based care to prevent all types of pressure injuries, including medical device‐related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries. Relevance to clinical practice Nursing interventions should consist of evidence‐based ‘bundles’ and be adapted to patients’ needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

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Section: Discussionmentioning

confidence: 99%

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

Alshahrani

Sim

Middleton

2021

Journal of Clinical Nursing

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“…The special mattresses and pillows were so effective that some subjects remained in the prone position for the entire sleeping period, i.e., no changes in sleeping position. Given the positive physiologic roles of changing the sleeping position [31][32][33], it is better for patients with POSA to avoid the supine position while not suppressing natural changes in the sleeping body position. As a less stringent intervention, use of a body pillow significantly increased the duration of sustained lateral body position while also allowing for changes in sleeping positions.…”

Section: Discussionmentioning

confidence: 99%

Effects of Body Pillow Use on Sleeping Posture and Sleep Architecture in Healthy Young Adults

Park

Suzuki

et al. 2021

Sleep Med Res

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Background and ObjectiveaaPatients with position-dependent obstructive sleep apnea have a > 2-fold higher apnea-hypopnea index when sleeping in a supine position compared with a nonsupine position. We investigated the effect of body pillow use on sleeping body position and sleep architecture in healthy young adults. MethodsaaIn experiment 1, we evaluated the body pressure distribution with or without body pillow use in 8 healthy young adults [age, 36.5 ± 13.0 years; body mass index (BMI); 20.6 ± 1.2 kg/ m 2 ]. In experiment 2, we performed a randomized-crossover intervention study to evaluate the effects of body pillow use on sleeping position and sleep architecture in 10 healthy young adults (age, 24.3 ± 7.8 years; BMI, 21.4 ± 1.7 kg/m 2 ). Sleep architecture was characterized by polysomnography, and body positions were monitored using a sensor. Subjective sleep quality was evaluated with the Oguri-Shirakawa-Azumi sleep inventory, middle age and aged version. ResultsaaIn experiment 1, body pillow use significantly reduced mean body pressure on the shoulder, hip, and whole body. In experiment 2, mean time spent in the supine, lateral, and prone body positions did not differ significantly between the 2 trials. Body pillow use, however, significantly extended the sustained time spent in the lateral body position compared with the control trial. Subjective sleep quality and sleep architecture did not differ significantly between the 2 trials, but body pillow use decreased the number of short (30 s) slow-wave sleep episodes. ConclusionsaaSleeping with a body pillow effectively extends sustained time in a lateral sleeping position and prevents segmentation of slow-wave sleep episodes.

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“…Positioning the body is an important pressure injury prevention strategy. Positioning refers to the movement and placement of the patient's body, for example, to rest in the side‐lying lateral tilt position or the supine position 4 . Body positioning has the potential to redistribute pressure and shear forces, and subsequently prevent the internal tissue deformation, tissue ischaemia, and irreversible tissue damage that causes pressure injuries 5 .…”

Section: Introductionmentioning

confidence: 99%

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

Sousa

Kapp

Santamaria

2020

International Wound Journal

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The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side‐lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose‐designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose‐designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high‐risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z‐Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side‐lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°‐26°, the foam wedge 29°‐27°, and the pillow 23°‐21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°‐71°, a difference of 7°) and the pillow alone (79°‐74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°‐86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.

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Lateral positioning for critically ill adult patients

Cited by 5 publications

References 32 publications

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

Effects of Body Pillow Use on Sleeping Posture and Sleep Architecture in Healthy Young Adults

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

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