Evidence-based nursing interventions and guidelines for prone positioning of adult, ventilated patients: A systematic review

Abstract

Although the prone positioning of a critically ill patient poses a challenge to nursing interventions, it remains the responsibility of nurses to develop a way to provide the same basic and intensive care to those patients lying prone as to those lying supine. The purpose of this study was firstly to conduct a systematic review of the literature as exploration and description of the evidence in support of the beneficial nursing interventions during prone positioning of ventilated patients, and secondly to develop evidence-based nursing guidelines for the nursing process. This exploratory, descriptive and retrospective systematic review includes data from 45 clinical trials, with a total population of 2 148 patients. Data was extracted onto data abstraction forms, assessed for methodological quality and finally summarised in evidence tables. All statistical calculations for the meta-analysis were performed by the RevMan 4.2.8 program. Prone positioning showed significant (p < 0.0001) increases in the partial pressure of oxygen in arterial blood (PaO2) weighted mean difference (WMD = 11.43) and the partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio (WMD = 21.58, 95% CI = 11.36; 31.8). The effects of complications, oxygenation and haemodynamic outcomes compared with the different prone-positioning protocols produced inconclusive results. Nursing guidelines for prone positioning were developed based on the best available evidence. The lack of related articles on nursing care of prone positioning was a drawback. Based on these results, recommendations are made towards further study on the nursing care of prone-positioned patients.

Opsomming
Hoewel maaglêposisionering van die pasiënt, wat in ‘n kritieke toestand is, ‘n uitdaging aan verpleegsorg bied, is dit steeds die verantwoordelikheid van die verpleegkundige om dieselfde basiese en kritieke sorg aan pasiënte te lewer in die maaglêposisie as aan pasiënte in die rugliggende posisie. Die doel van hierdie navorsing is eerstens om ‘n sistematiese ontleding van die literatuur te doen as verkennende en beskrywende bewyse van die voordelige verpleegintervensies gedurende maaglêposisionering van geventileerde pasiënte, en tweedens om navorsingsgebaseerde verpleegriglyne op te stel wat die verpleegproses betref. Hierdie verkennende, beskrywende en retrospektiewe sistematiese ontleding sluit data in van 45 kliniese proewe met ‘n totale populasie van 2 148 pasiënte. Data is deur middel van ‘n gestandardiseerde data- ontledingsvorm verkry, vir die metodologiese kwaliteit daarvan geassesseer en in dataonttrekkingstabelle opgesom. Alle statistiese verwerkings vir die meta-analise is deur die RevMan 4.2.8-program gedoen. Maaglêposisionering het beduidende toenames (p < 0.0001) in die arteriële suurstofdruk (PaO2) geweegde gemiddelde verskil (GMV = 11.43) en die arteriële suurstofdruk/fraksie van geïnspireerde suurstof-verhouding (PaO2/FiO2) (GMV = 21.58, 95% CI = 11.36; 31.8) getoon. Die effek van die komplikasie-, oksigenerings-, en hemodinamiese uitkomste in vergelyking met die verskillende maaglêposisione-ringsprotokolle het onbeduidende resultate gelewer. Verpleegriglyne vir maaglêposisionering is opgestel volgens die beste beskikbare navorsingsbewyse. Die tekort aan verpleegsorgverwante artikels oor maaglêposisionering word as ‘n leemte beskou. Op grond van hierdie resultate word aanbevelings gemaak vir verdere studies oor die verpleegsorg van maagliggende pasiënte.