# Evidence on Measures for the Prevention of Pressure Injuries in Mechanically Ventilated Patients in Prone Positioning: A Systematic Review

## TL;DR

This review finds that preventive strategies like dressings and care bundles can reduce pressure injuries in ventilated patients placed on their stomachs.

## Contribution

The study systematically evaluates the effectiveness of pressure injury prevention measures during prone positioning in mechanically ventilated patients.

## Key findings

- Preventive interventions such as dressings and care bundles reduced pressure injury incidence.
- Structured protocols with staff training and coordination showed greater effectiveness.
- Facial and anterior body regions saw the most improvement in injury prevention.

## Abstract

Background: Therapeutic prone positioning is widely used to improve oxygenation in patients with acute respiratory distress syndrome but is associated with an increased risk of pressure injuries, particularly affecting facial and anterior body regions. Methods: This systematic review was conducted according to PRISMA 2020 and Joanna Briggs Institute guidelines and was prospectively registered in PROSPERO (CRD42023442604). PubMed, CINAHL, Web of Science, Scopus, and the Cochrane Library were searched from inception to June 2025, including grey literature. Primary studies involving adult, mechanically ventilated patients undergoing therapeutic prone positioning and evaluating pressure injury prevention strategies were included. Methodological quality was assessed using JBI critical appraisal tools. Owing to clinical and methodological heterogeneity, findings were synthesized using a Synthesis Without Meta-analysis (SWiM) approach. Results: Eight studies with heterogeneous designs were included. Preventive interventions mainly comprised prophylactic dressings, repositioning and support devices, and comprehensive care bundles. Most strategies were associated with a reduction in pressure injury incidence, particularly in facial and anterior anatomical areas. Greater effectiveness was observed when interventions were implemented within structured protocols supported by staff training and multidisciplinary coordination. Conclusions: Preventive strategies appear effective in reducing pressure injuries associated with prone positioning in critically ill patients. The implementation of standardized, bundled prevention protocols may improve patient safety in intensive care settings.