Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID‐19 pandemic

Abstract

Prone positioning is used for surgical access and recently in exponentially growing numbers of coronavirus disease 2019 patients who are ventilated prone. To reduce their facial pressure ulcer risk, prophylactic dressings can be used; however, the biomechanical efficacy of this intervention has not been studied yet. We, therefore, evaluated facial soft tissue exposures to sustained mechanical loads in a prone position, with versus without multi‐layered silicone foam dressings applied as tissue protectors at the forehead and chin. We used an anatomically realistic validated finite element model of an adult male head to determine the contribution of the dressings to the alleviation of the sustained tissue loads. The application of the dressings considerably relieved the tissue exposures to loading. Specifically, with respect to the forehead, the application of a dressing resulted in 52% and 71% reductions in soft tissue exposures to effective stresses and strain energy densities, respectively. Likewise, a chin dressing lowered the soft tissue exposures to stresses and strain energy densities by 78% and 92%, respectively. While the surgical context is clear and there is a solid, relevant need for biomechanical information regarding prophylaxis for the prone positions, the projected consequences of the coronavirus pandemic make the present work more relevant than ever before.

COVID-19 related pressure injuries in patients and personnel: A systematic review

“…There were 4 studies [ 12 , [24] , [25] , [26] ] (3 case reports and 1 case-control study) identified. It was ascertained that the main sites of pressure injuries were on the forehead, chin, cheeks, lips and chest ( Fig.…”

“…In cases of severe ARDS, prone positioning of patients not only control the airways to provide mechanical invasive ventilation, but also reduce the mortality of patients [ 10 , 11 ]. The pressure injuries caused by it has been identified as the most frequent complication [ 12 , 13 ].…”

Prevention of skin damage caused by the protective equipment used to mitigate COVID-19: monthly update

“…Much has been written demonstrating positive outcomes through the use of prophylactic dressings. Peko et al 6 explored the biomechanical efficacy of using prophylactic dressings, Mepilex Border Flex (Mölnlycke, Sweden). In their paper Peko et al 6 tested and evaluated how Mepilex Border Flex interacts with facial tissues of a prone head, using a computational anatomically-realistic 3D head model that reflects the shape, composition and mechanical behaviour of both the tissues and the applied dressings.…”

“…Peko et al 6 explored the biomechanical efficacy of using prophylactic dressings, Mepilex Border Flex (Mölnlycke, Sweden). In their paper Peko et al 6 tested and evaluated how Mepilex Border Flex interacts with facial tissues of a prone head, using a computational anatomically-realistic 3D head model that reflects the shape, composition and mechanical behaviour of both the tissues and the applied dressings. They concluded that although there are limited experimental studies in the form of clinical trials investigating prophylactic dressings in the prevention of PUs for patients in the prone position, the biomechanical evidence supports the use of these dressings to reduce facial PUs during prone positioning.…”

“…The use of a soft silicone-foam, multilayered prophylactic dressing is a practical solution in clinical care, and the present computational modelling work strongly supports this approach. 6…”