Chiumello et al (2006) suggested that thorax and pelvic supports should not be used in prone patients lying on air mattress beds in the ICU. The supports did not significantly affect intra-abdominal pressure and increased the likelihood of pressure sores.
Do you support the chest and pelvis at all when your patients are prone on air mattresses in ICU? And if you do, what do you use - and why?
At Stoke Mandeville and Wycombe Hospital Dr Tahir Ali has developed excellent resources for proning patients in ICU. Pillows are used to support chest and pelvis. As far as I know there have been no reports of pressure related injuries from the use of these.
In my ICU in Atlanta we place adhesive pads on pressure points on the face, chest and extremities, but do not support the chest or pelvis in manual pronation of intubated patients.
Thank you Raj. That seems to reflect much of UK practice. It's hard to challenge orthodoxy. My view is that the air pressure mattress works best at protecting the skin - not pillows.
Tony - thanks for your reply. That is similar to practice in many french ICUs. Foam pads (like Mepilx®) seems to be effective in preventing pressure ulcers in clinical trials and these together with no pillows makes more sense to me.
Thank you for this interesting discussion.
1) on the thorax support what kind of shape do you used (chest rolls ? plexus support? pyramidal shape?)
2) Do you have any practices on headrest system for prone position of intubated patient ? What type of product ? what shape?
Thank you in advance.
We are trying to help hospitals nearby.
Christophe
Standard pillows under chest and pelvis. Head directly on mattress or pillow if there is enough space.
in our place we do not support the chest or pelvis in manual pronation of intubated patients. I think pillows under the chest and pelvis.
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