Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study

Thomas C Rollinson; Luke A McDonald; Joleen Rose; Glenn Eastwood; Rahul Costa-Pinto; Lucy Modra; Maeda Akinori; Zoe Bacolas; James Anstey; Samantha Bates; Scott Bradley; Jodi Dumbrell; Craig French; Angaj Ghosh; Kimberley Haines; Tim Haydon; Carol L Hodgson; Jennifer Holmes; Nina Leggett; Forbes McGain; Cara Moore; Kathleen Nelson; Jeffrey Presneill; Hannah Rotherham; Simone Said; Meredith Young; Peinan Zhao; Andrew Udy; Ary Serpa Neto; Anis Chaba; Rinaldo Bellomo

doi:10.1016/j.aucc.2024.09.002

Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study

Aust Crit Care. 2024 Oct 14:101117. doi: 10.1016/j.aucc.2024.09.002. Online ahead of print.

Authors

Thomas C Rollinson¹, Luke A McDonald², Joleen Rose², Glenn Eastwood³, Rahul Costa-Pinto⁴, Lucy Modra⁴, Maeda Akinori⁵, Zoe Bacolas⁶, James Anstey⁷, Samantha Bates⁸, Scott Bradley⁹, Jodi Dumbrell¹⁰, Craig French⁸, Angaj Ghosh¹¹, Kimberley Haines¹², Tim Haydon¹³, Carol L Hodgson¹⁴, Jennifer Holmes¹³, Nina Leggett¹², Forbes McGain⁸, Cara Moore⁷, Kathleen Nelson¹⁵, Jeffrey Presneill⁷, Hannah Rotherham⁷, Simone Said¹¹, Meredith Young¹⁶, Peinan Zhao¹⁰, Andrew Udy¹⁷, Ary Serpa Neto¹⁸, Anis Chaba⁵, Rinaldo Bellomo¹⁹

Affiliations

¹ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia. Electronic address: [email protected].
² Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.
³ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
⁴ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
⁶ Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.
⁷ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁸ Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia.
⁹ Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia.
¹⁰ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹¹ Department of Intensive Care, Northern Health, VIC, Australia.
¹² Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia.
¹³ Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
¹⁴ Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁵ Department of Physiotherapy, Alfred Health, VIC, Australia.
¹⁶ Department of Intensive Care, Alfred Health, VIC, Australia.
¹⁷ Department of Intensive Care, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁸ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁹ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

PMID: 39406618
DOI: 10.1016/j.aucc.2024.09.002

Abstract

Background and aims: Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.

Design: Multicentre, retrospective observational study.

Methods: Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected.

Results: We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported.

Conclusions: Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.

Keywords: ARDS; COVID-19; Complications; Pressure Injuries; Prone positioning.