Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis

Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19-A Dutch National Survey

Background: Airway care interventions and prone positioning are used in critically ill patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) to improve oxygenation and facilitate mucus removal. At the onset of the COVID-19 pandemic, the decision-making process regarding the practice of airway care interventions and prone positioning was challenging. Objective: To provide an overview of the practice of airway care interventions and prone positioning during the second wave of the pandemic in the Netherlands. Method: Web-based survey design. Seventy ICU nurses, each representing one intensive care in the Netherlands, were contacted for participation. Potential items were generated based on a literature search and formulated by a multidisciplinary team. Questions were pilot tested for face and construct validity by four intensive care nurses from four different hospitals. Results: The response rate was 53/77 (69%). This survey revealed widespread use of airway care interventions in the Netherlands in COVID-19 patients, despite questionable benefits. Additionally, prone positioning was used in invasively and non-invasively ventilated patients. Conclusions: The use of airway care interventions and prone positioning is time consuming and comes with the production of waste. Further research is needed to assess the effectiveness, workload, and environmental impact of airway care interventions and prone positioning.

Eye Care Interventions in Critical/Surgical Patients in the Prone Position: Scoping Review

Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute’s methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: “What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?” The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority.

Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study

Purpose

We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU.

Materials and method

Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO₂/FiO₂) ratios, partial pressure of carbondioxide (PaCO₂), PEEP, and FiO₂ were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected.

Results

In all positions, PaO₂ value during PP was significantly higher than PaO₂ before and after prone position (p = 0.001). PaO₂ values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO₂ values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO₂/FiO₂ increases after proning compared to before proning. PaO₂/FiO₂ during PP were higher compared to before proning ones. PaO₂/FiO₂ during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO₂ levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient.

Conclusion

We believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

Clinical Efficacy, Healing Efficacy, and Safety Analysis of Skin Orbicularis Oculi Muscle Combined with Tissue Flap for Eyelid Trauma

This study investigates the efficacy, healing efficiency, and safety of skin orbicularis oculi muscle combined with tissue flap repair for eyelid trauma patients. According to the different methods of surgical intervention, this study chooses 78 cases of eyelid injury patients. This study sets up the joint intervention group and the routine repair group, including the joint intervention group adopting the orbicularis oculi muscle skin of composite tissue flap to repair surgery. The routine repair group is treated by conventional repair skin flap transfer operation. Spearman correlation coefficient is used to analyze the correlation between postoperative healing of eyelid trauma patients and quality of life (SF-36) and self-image satisfaction (BIS) scale scores. The surgical intervention of skin orbicularis oculi muscle combined with tissue flap for patients with eyelid trauma has a better plastic repair effect in clinical practice. It can also effectively reduce the risk of postoperative complications, which is conducive to improve the postoperative quality of life and self-image satisfaction of patients.