BACCN. Patient positioning (critical care patients): prone. 2018. (accessed 12 June 2020)

ICS guidance for prone positioning of the conscious COVID patient. 2020. (accessed 12 June 2020)

Bloomfield R, Noble DW, Sudlow A Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev. 2015; 2015:(11)

Intensive Care Society, Faculty of Intensive Care Medicine. Guidance for prone positioning in adult critical care. 2019. (accessed 12 June 2020)

Meng L, Qiu H, Wan L Intubation and ventilation amid the COVID-19 outbreak. Anaethesiology. 2020; 132:(6)1317-1332

National Institute for Health and Care Excellence. Pressure ulcers: prevention and management. 2014. (accessed 12 June 2020)

Sud S, Friedrich JO, Adhikari NK Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ. 2014; 186:(10)E381-E390

Tissue Viability Society. Pressure ulcer prevention guidance when nursing patients in the prone position. 2020a. (accessed 12 June 2020)

Tissue Viability Society. Skin care during proning checklist. 2020b. (accessed 12 June 2020)

Zhu J, Ji P, Pang J Clinical characteristics of 3062 COVID-19 patients: a meta-analysis. J Med Virol. 2020;

Pressure ulcers and the prone position

25 June 2020
3 min read
Volume 29 · Issue 12

The prevention of pressure ulcers (PU) is an important consideration for nurses and allied health professionals. To reduce PU incidence, health professionals are guided by National Institute for Health and Care Excellence (NICE) guidelines (2014). However, the guidelines do not refer to proning, prone nursing or nursing patients with acute respiratory distress syndrome (ARDS). Although this position has been used within critical care settings for patients with ARDS, the use of proning has seen a recent upsurge in the care of patients with COVID-19 (Zhu et al, 2020). Critical care clinicians treating these patients have reported good responses to ventilation in the prone position, leading to this being recommended in international guidelines (Bamford et al, 2020). Proning in these circumstances, usually for more than 16 hours per day, leads to an increased risk of pressure ulcers. A survey of their members by the Intensive Care Society (ICS) and the Faculty of Intensive Care Medicine (FICM) (2019) identified pressure ulcers as the most cited complication.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content