Effect of modified prone position ventilation on oxygenation index and skin pressure injury in ARDS patients undergoing mechanical ventilation
Objective To evaluate the effect of modified prone position ventilation(PPV)on oxygenation index and skin pressure injury in mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods A total of 56 ARDS patients treated in the ICU of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,from December 1,2022,to June 30,2023,were selected.According to the mode of PPV treatment,patients were divided into a conventional group and a modified group,with 28 patients in each group.Each group was further divided based on treatment duration into 6-hour and 12-hour subgroups,with 14 patients in each subgroup.The conventional group changed the head position every 2 hours,returning to the supine position after treatment.The modified group alternated turning every 2 hours and also returned to the supine position after treatment.The oxygenation index,incidence of pressure injuries,and severity of pressure injuries were compared before and after the intervention.Results After intervention,the oxygenation index in all groups was higher than that before the intervention.The improvement in the oxygenation index in the modified 12-hour group and conventional 12-hour group showed statistically significant differences(P<0.05).However,no statistically significant differences were observed in the oxygenation index of the modified 6-hour group and conventional 6-hour group(P>0.05).As indicated by the comparison of the incidence of pressure injuries between the conventional and modified groups,the conventional group had a significantly higher incidence(92.86%,26/28)than the modified group(67.86%,19/28)(P<0.05).The incidence rates of pressure injuries in the conventional 6-hour group,conventional 12-hour group,modified 6-hour group,and modified 12-hour group were 85.7%(12/14),100%(14/14),57.14%(8/14),and 78.57%(11/14),respectively,with no significant differences between groups(P>0.05).The number of pressure injury sites in the conventional 6-hour group,conventional 12-hour group,modified 6-hour group,and modified 12-hour group were 21,58,14,and 36,respectively.The pressure injury scores were(1.71±1.33),(7.14±3.21),(1.43±1.55),and(3.14±2.11),respectively.The pressure injury score in the conventional group was(7.35±3.92),significantly higher than(4.00±1.45)in the modified group(P<0.05).In the 12-hour groups,the number of pressure injury sites and the pressure injury scores were significantly higher than those in the 6-hour groups(P<0.05).The pressure injury score in the conventional 12-hour group was higher than that in the modified 12-hour group(P<0.05).The pressure injury score in the conventional 6-hour group was higher than that in the modified 6-hour group,but the difference was not statistically significant(P>0.05).Conclusion A 12-hour PPV intervention can effectively improve the oxygenation index in ARDS patients.However,prolonged PPV increases the risk of pressure injury.The modified PPV mode can reduce pressure injury caused by long-term PPV.
pressure injurymodified prone position ventilationmechanical ventilationacute respiratory distress syndrome
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