Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review

Abstract

Objective: to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19. Method: this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data. Results: prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO2/FiO2 ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported. Conclusion: positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.

Nursing knowledge and practices regarding placing patients in the prone position: a descriptive study

“…Reports concerning the use of devices intended to promote comfort and protect patients against pressure injuries stood out, in addition to the care required by enteral nutrition. Hence, the literature recommends that cushions be strategically positioned to support the face, chest, wrists, pelvis, and the thighs anterior region, and bony prominences, to decrease injuries resulting from the position (12) . Still, the patients' skin must be periodically assessed, checking for moisture, friction, or shear (13) .…”

Perfil Clínico dos Pacientes Diagnosticados com Covid-19 Internados em uma Unidade de Terapia Intensiva

“…Na literatura há fortes evidências que a posição de prona nos pacientes com insuficiência respiratória aguda provocada por COVID-19 possuem desfecho positivo, como redução da hipoxemia e de mortalidade. [9][10][11] No presente estudo a posição prona foi utilizada com menor ocorrência que o esperado, atualmente já há evidências e protocolos estabelecidos para tal prática.…”

Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19

“…Para la selección de los resultados se tuvo en cuenta la población del contexto del artículo (pacientes críticos con SDRA secundaria a COVID-19 en posición prona, en unidades de cuidados intensivos y sedados) 52 y los vínculos NANDA-I, NOC y NIC. Por tanto, sugerimos dos resultados para monitorizar la efectividad de las intervenciones y evitar que se avance a diagnósticos reales de enfermería.…”