Protecting Prone Positioned Patients from Facial Pressure Ulcers Using Prophylactic Dressings: A Timely Biomechanical Analysis in the Context of the COVID-19 Pandemic

Abstract

Prone positioning is used for surgical access and recently, in exponentially growing numbers of coronavirus disease 2019 patients who are ventilated prone. To reduce their facial pressure ulcer risk, prophylactic dressings can be used, however, the biomechanical efficacy of this intervention has not been studied yet. We therefore evaluated facial soft tissue exposures to sustained mechanical loads in a prone position, with versus without multi-layered silicone foam dressings applied as tissue protectors at the forehead and chin. We used an anatomically-realistic validated finite element model of an adult male head to determine the contribution of the dressings to alleviation of the sustained tissue loads. Application of the dressings considerably relieved the tissue exposures to loading. Specifically, with respect to the forehead, application of a dressing resulted in 52% and 71% reductions in soft tissues exposures to effective stresses and strain energy densities, respectively. Likewise, a chin dressing lowered the soft tissue exposures to stresses and strain energy densities by 78% and 92%, respectively. While the surgical context is clear and there is solid, relevant need for biomechanical information regarding prophylaxis for the prone positions, the projected consequences of the coronavirus pandemic makes the present work more relevant than ever before.

Disclosure: This work was supported by an educational grant from Mölnlycke Health Care (Gothenburg, Sweden).