{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:37:22Z","timestamp":1777887442155,"version":"3.51.4"},"reference-count":32,"publisher":"AACN Publishing","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In patients with acute respiratory distress syndrome, prone positioning improves oxygenation and reduces mortality. Pressure injuries occur frequently because of prolonged prone positioning in high-risk patients, and preventive measures are limited. This article describes 2 patients who developed minimal pressure injuries despite several prone positionings. Prevention strategies are also described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Findings<\/jats:title><jats:p>A 64-year-old man and a 76-year-old woman were admitted to the hospital with respiratory insufficiency. Due to acute respiratory distress syndrome, both patients were intubated and received mechanical ventilation and prone positioning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Diagnosis<\/jats:title><jats:p>Both patients had positive test results for SARS-CoV-2 and a diagnosis of acute respiratory distress syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Patient 1 was in prone position for 137 hours during 9 rounds of prone positioning; patient 2, for 99 hours during 6 rounds of prone positioning. The standardized pressure injury prevention bundle for prone positioning consisted of skin care, nipple protection with a multilayer foam dressing, a 2-part prone positioning set, and micropositioning maneuvers. For both patients, 2-cm-thick mixed-porosity polyurethane foam was added between skin and positioning set in the thoracic and pelvic areas and a polyurethane foam cushion was added under the head.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Patient 1 developed no pressure injuries. Patient 2 developed category 2 pressure injuries on the chin and above the right eye during deviations from the protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For both patients, the additional application of polyurethane foam was effective for preventing pressure injuries. These case reports support the addition of polyurethane foam to prevent pressure injuries in patients placed in the prone position.<\/jats:p><\/jats:sec>","DOI":"10.4037\/ccn2023559","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:06:52Z","timestamp":1680307612000},"page":"46-54","source":"Crossref","is-referenced-by-count":9,"title":["Pressure Injury Prevention in Patients in Prone Position With Acute Respiratory Distress Syndrome and COVID-19"],"prefix":"10.4037","volume":"43","author":[{"given":"Julia","family":"Ruhland","sequence":"first","affiliation":[{"name":"Julia Ruhland is a registered nurse in a COVID-19 intensive care unit, Department of Nephrology and Medical Intensive Care, Campus Benjamin Franklin, Charit\u00e9, Universit\u00e4tsmedizin Berlin, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"D\u00e4hnert","sequence":"additional","affiliation":[{"name":"Enrico D\u00e4hnert is a registered nurse and practice development manager for nursing, Business Division Nursing Directorate, Nursing Science, Charit\u00e9, Universit\u00e4tsmedizin Berlin."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Zilezinski","sequence":"additional","affiliation":[{"name":"Max Zilezinski is a registered nurse and research associate, Institute for Clinical Nursing Science, Charit\u00e9, Universit\u00e4tsmedizin Berlin."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Hauss","sequence":"additional","affiliation":[{"name":"Armin Hauss is a registered nurse, research associate, and quality improvement manager, Business Division Nursing Directorate, Nursing Science and Institute for Clinical Nursing Science, Charit\u00e9, Universit\u00e4tsmedizin Berlin."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2471","reference":[{"issue":"11","key":"2023040100064835200_","doi-asserted-by":"publisher","first-page":"2","DOI":"10.25646\/7169","article-title":"Krankheitsschwere der ersten COVID-19-Welle in Deutschland basierend auf den Meldungen gem\u00e4\u00df Infektionsschutzgesetz","volume":"5","author":"Schilling","year":"2020","journal-title":"J Health Monit"},{"issue":"suppl 11","key":"2023040100064835200_","doi-asserted-by":"publisher","first-page":"2","DOI":"10.25646\/7170","article-title":"Disease severity of the first COVID-19 wave in Germany using reporting data from the national notification system","volume":"5","author":"Schilling","year":"2021","journal-title":"J Health Monit"},{"key":"2023040100064835200_","unstructured":"Deutsche Gesellschaft f\u00fcr An\u00e4sthesiologie. 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