The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Springer Science and Business Media LLC - 2022
Mariachiara Ippolito1, Andrea Cortegiani1, Gíanni Biancofiore2, Salvatore Caiffa3, Antonio Corcione4, Gian Domenico Giusti5, Pasquale Iozzo6, Alberto Lucchini7, Paolo Pelosi8, Gabriele Tomasoni9, Antonino Giarratano6
1Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
2UOC Anestesia e Rianimazione Trapianti Dipartimento di Patologia chirurgica, medica, molecolare e dell’Area Critica, Università di Pisa. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
3Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132, Genoa, Italy
4Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Naples, Italy
5School of Nursing, Azienda Ospedaliera Universitaria di Perugia, Perugia, Italy
6Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
7General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
8Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
9First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy

Tóm tắt

Abstract Background The aim of this document is to support clinical decision-making concerning positioning and mobilization of the critically ill patient in the early identification and resolution of risk factors (primary prevention) and in the early recognition of those most at risk (secondary prevention). The addresses of this document are physicians, nurses, physiotherapists, and other professionals involved in patient positioning in the intensive care unit (ICU). Methods A consensus pathway was followed using the Nominal Focus Group and the Delphi Technique, integrating a phase of focused group discussion online and with a pre-coded guide to an individual phase. A multidisciplinary advisory board composed by nine experts on the topic contributed to both the phases of the process, to reach a consensus on four clinical questions positioning and mobilization of the critically ill patient. Results The topics addressed by the clinical questions were the risks associated with obligatory positioning and therapeutic positions, the effective interventions in preventing pressure injuries, the appropriate instruments for screening for pressure injuries in the ICU, and the cost-effectiveness of preventive interventions relating to ICU positioning. A total of 27 statements addressing these clinical questions were produced by the panel. Among the statements, nine provided guidance on how to manage safely some specific patients’ positions, including the prone position; five suggested specific screening tools and patients’ factors to consider when assessing the individual risk of developing pressure injuries; five gave indications on mobilization and repositioning; and eight focused on the use of devices, such as positioners and preventive dressings. Conclusions The statements may represent a practical guidance for a broad public of healthcare professionals involved in the management of critically ill patients.

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