Pressure injury prevention for COVID-19 patients in a prone position

Prone positioning is a method used to manage ventilator-associated lung injury and promote oxygenation in severe acute respiratory distress syndrome (ARDS). With the COVID-19 pandemic and ever-increasing numbers of patients presenting with clinical pictures of ARDS, critical care practice guidelines and governing bodies are recommending prone positioning for adult patients with ARDS related to severe COVID-19 infection. Complications associated with prone positioning in critical care have the potential to cause patient morbidity. Common complications with prone positioning include the development of pressure injuries (PIs) on the forehead, chest, pelvis, chin, shoulders, genitalia, iliac crest and knees. Ocular damage and musculoskeletal issues may also occur. These complications are largely avoidable by implementing appropriate interventions. This article summarises current best practice and literature on interventions to reduce skin injury and other complications associated with prone positioning of COVID-19 patients with ARDS.