Stirn- und Kinndekubitus bei beatmeten COVID-19-Patienten in Bauchlage – ein ungelöstes Problem?

Patienten mit einem schweren Lungenversagen profitieren davon, in Bauchlage positioniert zu werden. Dabei besteht allerdings die Gefahr, dass sich im Gesichtsbereich Dekubitus entwickeln. Betroffen sind derzeit auch viele COVID-19-Patienten. Die Erkrankung selbst und deren Therapie begünstigen die Dekubitus-Entstehung. In der Uniklinik Freiburg hat man sich die betroffenen Patienten genauer angesehen und die Erkenntnisse aus Studien und beschriebenen „Best-practice-Beispielen“ umgesetzt, um Dekubitus vorzubeugen.

Publication History

Article published online:
07 September 2021

• Literatur

• 1 Institut für Qualitätssicherung und Transparenz im Gesundheitswesen Bundesauswertung zum Erfassungsjahr 2018. Pflege: Dekubitusprophylaxe. Qualitätsindikatoren und Kennzahlen.; Berlin: 2019
• 2 Cox J. Pressure Injury Risk Factors in Adult Critical Care Patients: A Review of the Literature. Ostomy Wound Manage 2017; 63: 30-43
• 3 Lima Serrano M, González Méndez MI, Carrasco Cebollero FM. et al Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. Med Intensiva 2017; 41: 339-46
• 4 Nijs N, Toppets A, Defloor T. et al Incidence and risk factors for pressure ulcers in the intensive care unit. J Clin Nurs 2009; 18: 1258-66
• 5 Willems MC, Voets AJ, Welten RJ. Two unusual complications of prone-dependency in severe ARDS. Intensive Care Med 1998; 24: 276-77
• 6 Gattinoni L, Tognoni G, Pesenti A. et al Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001; 345: 568-73
• 7 Munshi L, Del Sorbo L, Adhikari NKJ. et al Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2017; 14: S280-8
• 8 Sud S, Sud M, Friedrich JO. et al Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ Can Med Assoc J J Assoc Medicale Can 2008; 178: 1153-61
• 9 Girard R, Baboi L, Ayzac L. et al The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med 2014; 40: 397-403
• 10 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI). DIVI Intensivregister. DIVI-Intensiv 2021. Im Internet: bit.ly/3iNlhgo; Stand: 17.06.2021
• 11 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. EPUAP/NPIAP/PPPIA; 2019
• 12 Ibarra G, Rivera A, Fernandez-Ibarburu B. et al Prone position pressure sores in the COVID-19 pandemic: The Madrid experience. J Plast Reconstr Aesthetic Surg. 2020 Dec 26: S1748–6815(20)30732–4
• 13 Shearer SC, Parsa KM, Newark A. et al Facial Pressure Injuries from Prone Positioning in the COVID-19 Era. Laryngoscope 2021; 131 (07) E2139-E2142
• 14 Jiang ST, Fang CH, Chen JT. et al The Face of COVID-19: Facial Pressure Wounds Related to Prone Positioning in Patients Undergoing Ventilation in the Intensive Care Unit. Otolaryngol Neck Surg 2021; 164: 300-1
• 15 Perrillat A, Foletti JM, Lacagne AS. et al Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?. J Stomatol Oral Maxillofac Surg 2020; 121: 442-4
• 16 Ramondetta A, Ribero S, Costi S. et al Pression-induced facial ulcers by prone position for COVID-19 mechanical ventilation. Dermatol Ther 2020; 33: e13748
• 17 Gefen A, Ousey K. COVID-19: pressure ulcers, pain and the cytokine storm. J Wound Care 2020; 29: 540-2
• 18 Prebio M, Katz-Papatheophilou E, Heindl W. et al Verminderung von Hautdefekten bei Bauchlagerung bei beatmeten Intensivpatienten durch das Prone-Head-Support-System: eine Pilotstudie. Wien Klin Wochenschr 2005; 117: 98-105
• 19 Grisell M, Place HM. Face tissue pressure in prone positioning: a comparison of three face pillows while in the prone position for spinal surgery. Spine (Phil Pa 1976) 2008; 33: 2938-41
• 20 Haleem S, Mihai R, Rothenfluh DA. et al Preventing iatrogenic facial pressure ulcers during spinal surgery: Prospective trial using a novel method and review of literature. Int Wound J 2020; 17: 1391-5
• 21 Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J 2020; 17: 1595-606
• 22 Kim RS, Mullins K. Preventing Facial Pressure Ulcers in Acute Respiratory Distress Syndrome (ARDS). J Wound Ostomy Continence Nurs 2016; 43: 427-9
• 23 Jackson ME, Verano JX, Fry JE. et al Skin Preparation Process for the Prevention of Skin Breakdown in Patients Who Are Intubated and Treated With RotoProne. Respir Care 2012; 57: 311-4
• 24 Bunker DLJ, Thomson M. Chin Necrosis as a Consequence of Prone Positioning in the Intensive Care Unit. CASE Rep Med 2015: 2015
• 25 Lucchini A, Bambi S, Mattiussi E. et al Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications. Dimens Crit Care Nurs DCCN 2020; 39: 39-46