Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19

Palabras clave: Prevención & control, Úlcera por presión, Posición prona, Infecciones por Coronavirus, Pandemias

Resumen

 

Resumen

Introducción: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión [00249], de deterioro de la integridad cutánea [00047] y tisular [00248].  Por su parte, la intervención de enfermería prevención de úlceras por presión [3540], es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas [0204] e integridad tisular: piel y membranas mucosas [1101]. Conclusión: La PP es una terapia coadyuvante  recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población.

Cómo citar este artículo: Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. Revista Cuidarte. 2021;12(3):e2234. http://dx.doi.org/10.15649/cuidarte.2234

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Biografía del autor/a

Lyda Zoraya Rojas, Fundación Cardiovascular de Colombia

Fundación Cardiovascular de Colombia, Grupo de Investigación y Desarrollo de Conocimiento en Enfermería GIDCEN, Floridablanca, Colombia.

Liliana Andrea Mora Rico, Hospital Internacional de Colombia, Piedecuesta, Colombia

Hospital Internacional de Colombia, Piedecuesta, Colombia

Jennifer Vanesa Acosta Barón, Hospital Internacional de Colombia

Hospital Internacional de Colombia, Piedecuesta, Colombia.

Luisa Yaneth Cristancho Zambrano, Hospital Internacional de Colombia

Hospital Internacional de Colombia, Piedecuesta, Colombia.

Yurley Dayanna Valencia Barón, Fundación Cardiovascular de Colombia

Fundación Cardiovascular de Colombia, Centro de Investigaciones, Floridablanca, Colombia.

Juliana Alexandra Hernández Vargas, Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo

Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, Grupo de Investigación y Desarrollo de Conocimiento en Enfermería GIDCEN. Cundinamarca, Colombia.

Citas

Barker J, Koeckerling D, West R. A need for prone position CPR guidance for intubated and non-intubated patients during the COVID-19 pandemic. Resuscitation. 2020. 151:135-6. https://doi.org/10.1016/j.resuscitation.2020.04.029

Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med. 2020. 8(8):765-74. https://doi.org/10.1016/S2213-2600(20)30268-X

Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017. 195(1):67-77. https://doi.org/10.1164/rccm.201606-1306OC

Guerin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018. 44(1):22-37. https://doi.org/10.1007/s00134-017-4996-5

Barakat-Johnson M, Carey R, Coleman K, Counter K, Hocking K, Leong T, et al. Pressure injury prevention for COVID-19 patients in a prone position. Wound Practice and Research. 2020. 28(2):50-7. https://doi.org/10.33235/wpr.28.2.50-57

Settembre N, Maurice P, Paysant J, Theurel J, Claudon L, Kimmoun A, et al. The use of exoskeletons to help with prone positioning in the intensive care unit during COVID-19. Ann Phys Rehabil Med. 2020. 63(4):379-82. https://doi.org/10.1016/j.rehab.2020.05.004

Schub E, Pilgrim J. Patient positioning (critical care patients): prone. Nursing practice & Skill. 2018. https://www.baccn.org/static/uploads/resources/NRCP_Prone_Position_ICU_pt.pdf

Ghelichkhani P, Esmaeili M. Prone Position in Management of COVID-19 Patients; a Commentary. Arch Acad Emerg Med. 2020. 8(1):e48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

Mora-Arteaga JA, Bernal-Ramirez OJ, Rodriguez SJ. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med Intensiva. 2015. 39(6):359-72. https://doi.org/10.1016/j.medine.2014.11.004

Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc. 2017. 14(Supplement_4):S280-S8. https://doi.org/10.1513/AnnalsATS.201704-343OT

Stephen-Haynes J, Maries M. Pressure ulcers and the prone position. Br J Nurs. 2020. 29(12):S6. https://doi.org/10.12968/bjon.2020.29.12.S6

Bentley SK, Iavicoli L, Cherkas D, Lane R, Wang E, Atienza M, et al. Guidance and Patient Instructions for Proning and Repositioning of Awake, Nonintubated COVID-19 Patients. Acad Emerg Med. 2020. https://doi.org/10.1111/acem.14067

Bamford P, Bentley A, Dean J, Whitmore D, Wilson-Baig N. ICS Guidance for Prone Positioning of the Conscious COVID Patient 2020. Intensive care society. https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-conscious-proning.pdf

Albott CS, Wozniak JR, McGlinch BP, Wall MH, Gold BS, Vinogradov S. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg. 2020. 131(1):43-54. https://doi.org/10.1213/ANE.0000000000004912

Shearer SC, Parsa KM, Newark A, Peesay T, Walsh AR, Fernandez S, et al. Facial Pressure Injuries from Prone Positioning in the COVID-19 Era. Laryngoscope. 2021. https://doi.org/10.1002/lary.29374

Rodriguez-Huerta MD, Diez-Fernandez A, Rodriguez-Alonso MJ, Robles-Gonzalez M, Martin-Rodriguez M, Gonzalez-Garcia A. Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS-CoV-2 pulmonary infection. Nurs Crit Care. 2021. https://doi.org/10.1111/nicc.12606

Ibarra G, Rivera A, Fernandez-Ibarburu B, Lorca-Garcia C, Garcia-Ruano A. Prone position pressure sores in the COVID-19 pandemic: The Madrid experience. J Plast Reconstr Aesthet Surg. 2020. https://doi.org/10.1016/j.bjps.2020.12.057

Capasso V, Cox J, Cuddigan J, Delmore B, Tescher A, Solmos S. Pressure injury prevention-pip tips for prone positioning. National pressure injury advisory panel. 2020 https://cdn.ymaws.com/npiap.com/resource/resmgr/online_store/posters/npiap_pip_tips_-_proning_202.pdf

Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J. 2020. https://doi.org/10.1111/iwj.13435

Kim RS, Mullins K. Preventing Facial Pressure Ulcers in Acute Respiratory Distress Syndrome (ARDS). J Wound Ostomy Continence Nurs. 2016. 43(4):427-9. https://doi.org/10.1097/WON.0000000000000247

Zingarelli EM, Ghiglione M, Pesce M, Orejuela I, Scarrone S, Panizza R. Facial Pressure Ulcers in a COVID-19 50-year-old Female Intubated Patient. Indian J Plast Surg. 2020. 53(1):144-6. https://doi.org/10.1055/s-0040-1710403

Perrillat A, Foletti JM, Lacagne AS, Guyot L, Graillon N. Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?. J Stomatol Oral Maxillofac Surg. 2020. https://doi.org/10.1016/j.jormas.2020.06.008

Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014. 70(10):2222-34. https://doi.org/10.1111/jan.12405

Boyko TV, Longaker MT, Yang GP. Review of the Current Management of Pressure Ulcers. Adv Wound Care (New Rochelle). 2018. 7(2):57-67. https://doi.org/10.1089/wound.2016.0697

Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. JAMA Intern Med. 2020. https://doi.org/10.1001/jamainternmed.2020.3596

Taneri PE, Gomez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Diaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020. https://doi.org/10.1101/2020.06.04.20122267

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020. https://doi.org/10.1001/jama.2020.5394

Herramienta online para la consulta y diseño de planes de cuidados de enfermería. NNNConsult. Elsevier. 2015 [cited 2021Abril08]. http://www.nnnconsult.com/

Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care. 2020. 29(6):312-20. https://doi.org/10.12968/jowc.2020.29.6.312

Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, et al. Device-related pressure ulcers: SECURE prevention. J Wound Care. 2020. 29(Sup2a):S1-S52. https://doi.org/10.12968/jowc.2020.29.Sup2a.S1

Park SH, Lee YS, Kwon YM. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis. West J Nurs Res. 2016. 38(4):459-83. https://doi.org/10.1177/0193945915602259

Park SH, Lee HS. Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis. Iran J Public Health. 2016. 45(2):122-33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841867/

European Pressure Ulcer Advisory Panel NPIAPaPPPIA. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The International Guideline. 2019. 3rd: http://www.internationalguideline.com

Girard R, Baboi L, Ayzac L, Richard JC, Guerin C, Proseva trial g. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014. 40(3):397-403. https://doi.org/10.1007/s00134-013-3188-1

Baktoft B. Nursing care of patients in the prone position. The World of Critical Care Nursing. 2001. 1(3):83-6. https://doi.org/10.1891/1748-6254.1.3.87

Lucchini A, Bambi S, Mattiussi E, Elli S, Villa L, Bondi H, et al. Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications. Dimens Crit Care Nurs. 2020. 39(1):39-46. https://doi.org/10.1097/DCC.0000000000000393

Barakat-Johnson M, Lai M, Wand T, Li M, White K, Coyer F. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. J Wound Care. 2019. 28(8):512-21. https://doi.org/10.12968/jowc.2019.28.8.512

Black J, Alves P, Brindle CT, Dealey C, Santamaria N, Call E, et al. Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices. Int Wound J. 2015. 12(3):322-7. https://doi.org/10.1111/iwj.12111

Park KH, Kim KS. Effect of a structured skin care regimen on patients with fecal incontinence: a comparison cohort study. J Wound Ostomy Continence Nurs. 2014. 41(2):161-7. https://doi.org/10.1097/WON.0000000000000005

Avsar P, Karadag A. Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis. Worldviews Evid Based Nurs. 2018. 15(1):54-61. https://doi.org/10.1111/wvn.12264

Otero DP, Dominguez DV, Fernandez LH, Magarino AS, Gonzalez VJ, Klepzing JV, et al. Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial. J Wound Care. 2017. 26(3):128-36. https://doi.org/10.12968/jowc.2017.26.3.128

Weng MH. The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive Crit Care Nurs. 2008. 24(5):295-9. https://doi.org/10.1016/j.iccn.2007.11.005

Prebio M, Katz-Papatheophilou E, Heindl W, Gelbmann H, Burghuber OC. Reduction of pressure sores during prone positioning of ventilated intensive care patients by the prone-head support system: a pilot study. Wien Klin Wochenschr. 2005. 117(3):98-105. https://doi.org/10.1007/s00508-004-0299-2

Katzengold R, Gefen A. What makes a good head positioner for preventing occipital pressure ulcers. Int Wound J. 2018. 15(2):243-9. https://doi.org/10.1111/iwj.12857

Levy A, Kopplin K, Gefen A. Device-related pressure ulcers from a biomechanical perspective. J Tissue Viability. 2017. 26(1):57-68. https://doi.org/10.1016/j.jtv.2016.02.002

Grisell M, Place HM. Face tissue pressure in prone positioning: a comparison of three face pillows while in the prone position for spinal surgery. Spine. 2008. 33(26):2938-41. https://doi.org/10.1097/BRS.0b013e31818b9029

Kumagai A, Ohno N, Miyati T, Okuwa M, Nakatani T, Sanada H, et al. Investigation of effects of urethane foam mattress hardness on skin and soft tissue deformation in the prone position using magnetic resonance imaging. J Tissue Viability. 2019. 28(1):14-20. https://doi.org/10.1016/j.jtv.2018.10.007

Roth S. Perioperative visual loss: what do we know, what can we do?. Br J Anaesth. 2009. 103 Suppl 1:i31-40. https://doi.org/10.1093/bja/aep295

Gefen A, Farid KJ, Shaywitz I. A review of deep tissue injury development, detection, and prevention: shear savvy. Ostomy Wound Manage. 2013. 59(2):26-35. https://pubmed.ncbi.nlm.nih.gov/23388395/

Shi C, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS One. 2018. 13(2):e0192707. https://doi.org/10.1371/journal.pone.0192707

Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013. 368(23):2159-68. https://doi.org/10.1056/NEJMoa1214103

Araujo MS, Santos M, Silva CJA, Menezes RMP, Feijao AR, Medeiros SM. Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review. Rev Lat Am Enfermagem. 2021. 29:e3397. https://doi.org/10.1590/1518-8345.4732.3397

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987. 36(4):205-10. https://doi.org/10.1097/00006199-198707000-00002

Norton D, McLaren R, Exton-Smith A. An investigation of geriatric nursing problems in hospital. London: Churchill Livingstone. Scientific Research. 1962. https://www.scirp.org/(S(czeh2tfqyw2orz553k1w0r45))/reference/ReferencesPapers.aspx?ReferenceID=1191367

Drahnak DM, Custer N. Prone Positioning of Patients With Acute Respiratory Distress Syndrome. Crit Care Nurse. 2015. 35(6):29-37. https://doi.org/10.4037/ccn2015753

Publicado
2021-09-13
Cómo citar
1.
Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. Rev Cuid [Internet]. 13 de septiembre de 2021 [citado 28 de septiembre de 2021];12(3). Disponible en: https://revistas.udes.edu.co/cuidarte/article/view/2234
Sección
Artículo de Reflexión