Pressure ulcers and the prone position

The prevention of pressure ulcers (PU) is an important consideration for nurses and allied health professionals. To reduce PU incidence, health professionals are guided by National Institute for Health and Care Excellence (NICE) guidelines (2014). However, the guidelines do not refer to proning, prone nursing or nursing patients with acute respiratory distress syndrome (ARDS). Although this position has been used within critical care settings for patients with ARDS, the use of proning has seen a recent upsurge in the care of patients with COVID-19 (Zhu et al, 2020). Critical care clinicians treating these patients have reported good responses to ventilation in the prone position, leading to this being recommended in international guidelines (Bamford et al, 2020). Proning in these circumstances, usually for more than 16 hours per day, leads to an increased risk of pressure ulcers. A survey of their members by the Intensive Care Society (ICS) and the Faculty of Intensive Care Medicine (FICM) (2019) identified pressure ulcers as the most cited complication.