Perioral pressure ulcers in patients with COVID-19 requiring invasive mechanical ventilation
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ORIGINAL PAPER
Perioral pressure ulcers in patients with COVID-19 requiring invasive mechanical ventilation Aseel Sleiwah 1
&
Ganeshkrishna Nair 2 & Maleeha Mughal 1 & Katie Lancaster 1 & Imran Ahmad 2,3
Received: 20 May 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting. Methods A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality. Results Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days. Conclusions The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication. Level of evidence: Level IV, risk/prognostic study. Keywords Facial ulcers . Perioral ulcers . Pressure sores . Endotracheal intubation securing device
Introduction The global health pandemic with coronavirus disease 2019 (COVID-19) caused a huge surge in admissions to critical care units worldwide for respiratory support and management of acute respiratory distress syndrome * Aseel Sleiwah [email protected] 1
Department of Plastic Surgery, Guy’s & St. Thomas’ Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London SE1 7EH, UK
2
Department of Plastic Surgery, Guy’s & St. Thomas’ Hospital, London, UK
3
King’s College London, London, UK
(ARDS) [1, 2]. Ventilating in a prone position is an important strategy to manage seriously ill patients with ARDS in an attempt to increase arterial oxygenation and reduce ventilation-perfusion mismatch [3–5]. Securing the airway is crucial to prevent accidental extubation or dislodgment of the tube into the right bronchus. Several medical devices have been designed to achieve thi
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