Rollinson Thomas C, McDonald Luke A, Rose Joleen, Eastwood Glenn, Costa-Pinto Rahul, Modra Lucy, Akinori Maeda, Bacolas Zoe, Anstey James, Bates Samantha, Bradley Scott, Dumbrell Jodi, French Craig, Ghosh Angaj, Haines Kimberley, Haydon Tim, Hodgson Carol L, Holmes Jennifer, Leggett Nina, McGain Forbes, Moore Cara, Nelson Kathleen, Presneill Jeffrey, Rotherham Hannah, Said Simone, Young Meredith, Zhao Peinan, Udy Andrew, Serpa Neto Ary, Chaba Anis, Bellomo Rinaldo
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.
Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.
Aust Crit Care. 2025 Mar;38(2):101117. doi: 10.1016/j.aucc.2024.09.002. Epub 2024 Oct 15.
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.
Multicentre, retrospective observational study.
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.
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.
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.
俯卧位通气常用于改善患有2019冠状病毒病（COVID-19）相关急性呼吸窘迫综合征（ARDS）的机械通气患者的气体交换。虽然俯卧位通气有效，但可能会出现特定并发症。我们旨在评估因COVID-19相关ARDS接受机械通气的患者中与俯卧位通气相关的特定并发症的发生率。
多中心回顾性观察研究。
对2021年8月至11月在澳大利亚墨尔本重症监护病房住院的因COVID-19相关ARDS接受机械通气的患者进行多中心观察研究。收集了关于基线特征、俯卧位通气、并发症和患者结局的数据。
我们评估了7个地点220例患者的553次俯卧位通气情况（平均±标准差年龄：54±13岁，61%为男性）。总体而言，58%（127/220）的患者经历了至少一种与俯卧位通气相关的并发症。压力性损伤是报告的最常见并发症（n = 92/220，42%）。与压力性损伤风险增加相关的因素为男性（调整后的优势比 = 1.15，95%置信区间：[1.02 - 1.31]）和俯卧位通气的总次数（调整后的优势比 = 1.11，95%置信区间：[1.07 - 1.15]）。设备移位是第二常见的并发症，发生在220例患者中的28例（13%）。未报告神经或视网膜损伤。
压力性损伤和管路移位是与因COVID-19接受机械通气的患者俯卧位通气相关的最常见并发症。压力性损伤的风险与男性及俯卧位通气次数有关。
