[Reduction of pressure sores during prone positioning of ventilated intensive care patients by the prone-head support system: a pilot study].
OBJECTIVE
Prone positioning in patients with adult respiratory distress syndrome is a well-known method to improve oxygenation. The aim of our study was to evaluate a new device for prone positioning, the prone-head support system (PHS system), with regard to reduction of cutaneous pressure sores.


METHODS
In a pilot study we randomized 8 patients with ARDS in two groups: 180 degrees standard prone positioning (group without mask) and prone positioning with the PHS system (group with mask). The PHS system consists of a facemask support, which is connected to an adapted air suspension bed. The patients of both groups were intermittently proned for several days. We evaluated the pressure sores on head and neck before turning the patients prone for the first time and after each period of prone positioning. We documented the quantity, the size, the type and the localization of the pressure sores.


RESULTS
There was no significant difference in the mean duration of prone positioning (27.1+/-14.7 hours in the group with mask versus 24.5+/-18.7 h in the group without mask). In the group with mask there were 1.5+/-0.8 new pressure sores by each proning, whereas in the group without mask there were 2.37+/-1.6 new pressure sores, which was lower, but not significantly. The overall area of pressure sores (798 mm2 versus 3184 mm2, p=0.004), the area of pressure sores per patient (199.5+/-104.7 mm2 versus 796+/-478 mm2, p=0.03) and the increase of the area of pressure sores per proning (79.8+/-52.0 mm2 versus 398.0+/-214.3 mm2, p=0.004) were significantly lower in the group with mask in comparison to the group without mask. The lips were the most effected localization in both groups. The pressure sores in the group with mask were less severe and showed a homogenous distribution in comparison to the group without mask. Blisters dominated in the group with mask in comparison to erosions, necrosis and ulcers in the group without mask.


CONCLUSIONS
The PHS system with its face mask is able to reduce the extent and the severity of pressure sores in patients ventilated in prone position. Controlled randomized studies with large study populations seem justified.
Prebio
Michael
M
Intensivstation, 1. Lungenabteilung, Otto-Wagner-Spital, Wien, Osterreich. michael.prebio@wienkav.at
Katz-Papatheophilou
Elfriede
E
Heindl
Werner
W
Gelbmann
Herbert
H
Burghuber
Otto C
OC
D000328:Adult; D000368:Aged; D001513:Beds; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000209:etiology* / Q000517:prevention & control*; D016684:Prone Position; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016896:Treatment Outcome