Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence

In December 2019, the first cases of pneumonia from a novel coronavirus were identified in Wuhan, China, and the pathogen was later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to official figures (https://coronavirus.data.gov.uk) up to 1 March 2021, 4 182 009 people had tested positive in the UK, 439 352 of them requiring hospital admission. At the peak of COVID-19 admissions by the end of January 2021, more than 4000 occupied an intensive care unit (ICU) level 3 bed, those reserved for patients requiring either advanced respiratory support or two or more organ system support. Patients with COVID-19 often present with acute respiratory distress syndrome (ARDS), requiring management in the prone position for up to 16 hours, several times, which presents a challenge for health professionals to maintain skin integrity (Worsley et al, 2020).

Prone positioning is a postural therapy where the patient lies in a horizontal position facing down, which aims to enhance the oxygenation and lung compliance of patients who develop moderate or severe ARDS, a condition experienced by 67-85% of critically ill COVID-19 patients admitted to ICU (Moore et al, 2020; Stephen-Haynes and Maries, 2020). The APRONET analysis, a prospective international study performed between April 2016 and January 2017 in 141 ICUs from 20 countries, revealed that 32.9% of patients with serious ARDS were ventilated in the prone position for prolonged periods of time, increasing their risk of facial pressure ulcers (PUs) (Moore et al, 2020).