Skin Prevention for Manual Prone Therapy in ARDS

The purpose of this project was to decrease the amount of skin breakdown in patients with severe acute respiratory distress syndrome (ARDS) who received prone therapy. ARDS is characterized by acute diffuse inflammation throughout the lungs, which causes the alveoli to fill with fluid. Research suggests that prone therapy results in a 16% mortality rate, compared to a 32.8% rate in patients remaining supine (Guerin et al., 2013). With a combination of decreased oxygen saturation, hemodynamic instability, malnutrition, utilization of deep sedation, chemical paralysis, and prone therapy, the patient is at high risk for developing skin breakdown. In prior practice, patients with severe ARDS received this treatment using automated prone therapy. Due to a combination of problems that included the amount of varying stages of skin breakdown from the use of automated prone positioning in the critical care units, manual prone positioning was implemented in attempts to remedy the issues associated with automated prone therapy. An education program was developed using a literature review of evidence-based practice pertinent to prone therapy, pressure ulcer prevention in patients with ARDS and device related pressure ulcer prevention. The program was used to train the critical care nurses of a large urban hospital, how to safely prone the patient manually and prevent skin breakdown with the use of a preventative skin care bundle. This was done so by video instruction and demonstration during various skills trainings and critical care classes for new staff. This bundle includes a turning and repositioning schedule, use of appropriately placed pillows and foam dressings, and use of a preventative surface, skin care mattress. Skin breakdown is noted to have dramatically decreased in occurrence and severity, since implementation of this preventative education program that is believed to be best practice in patients with severe ARDS.