Effect Of Prone Position At Different Angles On Pressure Injury In Machinery Ventilates Patients With ARDS

Purpose To explore the appropriate prone position for patients with ARDS which has a slight effect on hemodynamics and oxygenation parameters and has less possibility of incurring pressure injury.Method From January 2016 to January 2018,98 patients with mechanical ventilation in prone position who were admitted to the Intensive Care Department（ICU）of the first people’s Hospital of Yancheng were selected.The patients were randomly divided into routine group（33 cases）,30°prone position group（33 cases）and 45°prone position group（32cases）.In the routine group:0°continuous prone position for 16 hours.In the 30°prone position group:From 0°prone position to 30°left prone position then to 30°right prone position;patients were placed in each position for 2 hours,until 16 hours.In the 45°prone position group:From 0°prone position to 45°left prone position then to 45°right prone position;patients were placed in each position for 2 hours,until 16 hours.The difference in incidence of the pressure injury,location,number,stage,hemodynamic and oxygenation parameters among three groups.Results In 98 patients with prone position ventilation,13 patients were terminated for different reasons,including 5 in the routine group,5 in the 30°prone position group,3 in the 45°prone position group.The final experiment was performed in 85 patients,including28 in the routine group,28 in the 30°prone position group and 29 in 45°prone position group.1.There was no significant difference in baseline in each group before intervention.Age,sex,body mass index,Apache II score and sofa score,acute lung injury score,Braden pressure ulcer score,airway opening mode.There was no significant difference in mean mechanical ventilation time and serum albumin level in baseline（P>0.05）.2.Comparison of pressure injury in three groups1)The incidence of pressure injury was compared among three groups.In this study,a total of 35 patients suffered pressure injuries,which were in stage 1 and stage 2.They were 18 in the routine group,9in the 30°prone position group and 8 cases in the 45°prone position group.The incidence of pressure injury was 41.18%.There was significant difference in the incidence of pressure injury among the three groups（P<0.05）.2)In this study,three groups of patients with stress injury site composition were compared,the facial,shoulder,chest,hip,the occurrence of stress injury between the three groups showed a significant difference（P<0.05）.There was a significant difference between the 30°prone position and 45°prone position shoulder in terms of pressure-induced injury compared with the control group（P<0.05/3）.In the 45°prone position group,the incidence of chest pressure injury was significantly higher than that in the conventional group（P<0.05/3）.The hip pressure injury in the 30°prone position group was significantly higher than that in the conventional group（P<0.05/3）.3)The number and degree of pressure injury was compared among three groups.In this study,a total of 53 pressure injuries occurred in 18 patients in the routine group who had already had pressure injuries,with an average of（2.94±1.06）.On the other hand,33 and 26 pressure injuries occurred in the 30°prone position group and the 45°prone position group,respectively,with an average of（3.67±0.87）and（3.25±1.04）.There was significant difference in the incidence and number of pressure injuries in the stage 1 among the three groups（P<0.05）,30 degrees and 45 degrees prone group and conventional group than were statistically significant.There was no significant difference in the incidence of pressure injuries in the stage 2 between the three groups（P>0.05）.Compared with the conventional group,the number of 2-stage pressure injury in 45°prone group was statistically significant（p<0.05）.3.Effect of prone position at different angles on hemodynamics among three groups There was no significant difference in hemodynamic parameters between the three groups（P>0.05）.4.Effect of prone position at different angles on oxygenation in mechanical ventilation patients with ARDS In baseline,there was no significant difference in oxygenation parameters among three groups.Compared with the routine group and pre-intervention,SaO₂,PaO₂,P/F increased significantlyafter the prone position（P<0.05）.In the 30°prone position and 45°prone position,the PaO₂ and P/F were significantly higher than those before the prone position（P<0.05）.After the prone position,there was no statistically significant change in the oxygenation index（PaCO₂,PaO₂,SaO₂,P/F）between the three groups（P>0.05）.Conclusion1.Three different angles of prone position were more favorable than those before prone to oxygenation in patients with ARDS mechanical ventilation,and 30°and 45°prone position can significantly increase PaO₂,P/F.2.The incidence of pressure-induced injury in the conventional prone position group was lower than that in the conventional prone position group（30°and 45°prone position）.3.30°and 45°prone position is beneficial to the oxygenation 30°prone position in ARDS patients.There is no significant effect on the prevention of stage 1pressure-induced injury in the prone position of 30°or 45°prone position..45°prone position can reduce stage 2 pressure injury in ARDS patients.