2024 FSA Podium and Poster Abstracts
S005: PREVENTION OF FACIAL PRESSURE INJURIES IN PRONE POSITION
Christopher H Nam, MD; Brian M Osman, MD; Alexander M Harrington, MD, MBA; University of Miami Miller School of Medicine
Introduction: Procedures requiring prone positioning offer challenges with preventing pressure injuries, particularly in the face. They occur due to prolonged elevated pressure preventing blood flow to a specific area (3). Research, however, is limited on the optimal devices for prone head positioning.
Methods: We conducted a systematic literature search using PubMed for literature comparing prone positioning devices for the head.
Results: McMichael et al. compared 3 prone head positioners in 15 conscious individuals. The devices included a foam pillow (VOSS; Figure 1), a face plate and mirror with a foam head positioner (Proneview Protective Helmet System; Figure 2), and a neoprene “dry flotation” device (ROHO; Figure 3). At all time points, the Proneview and the ROHO pillow demonstrated lower pressures at the forehead and chin than the VOSS pillow (4).
Grisell et al. compared 3 similar devices in 66 patients undergoing spine surgery under general anesthesia. The devices were the OSI (Orthopedic Systems Inc.) foam pillow (similar to the VOSS pillow), and the Proneview and ROHO devices. The Proneview had the lowest forehead and chin pressures at all time points (3).
Atwater et al. also compared a T-shaped pillow (similar to OSI and VOSS positioners) with the ProneView in 35 awake patients. The T-shaped pillow had surface pressures that were 29% higher and had 80% more areas with pressure greater than 50mmHg. The authors note difficulty with avoiding the eyes with the T-shaped pillow (1).
Goodwin et al. described using Mayfield clamps in patients undergoing sacrectomy in the prone Kraske position. The Mayfield clamp is a 3-point skull fixation device that fixes the head in place. No patients developed facial pressure injuries, and the pinhole defects healed well(2).
Discussion: Limited research exists regarding optimal positioning devices for prevention of facial pressure injuries, although the Proneview helmet system and Mayfield pins have shown the most promising results. Proper positioning without neck flexion or extension has also been shown to reduce face pressure (1). Reducing intraoperative risk factors including maintenance of mean arterial pressure above 70mmHg, maintenance of normothermia, goal directed therapy with judicious use of fluids and blood products, and pressure point checks every 1-2 hours can potentially decrease pressure injuries. Optimizing patients prior to surgery to minimize preoperative risk factors including nutritional status, BMI, and modifiable diseases could also improve outcomes (3,4). These results could help develop guidelines in prone positioning for prevention of facial pressure ulcer injuries.
Figure 1
Figure 2
Figure 3
Sources:
1.Atwater BI, et al. Pressure on the face while in prone position: ProneView versus Prone Positioner. J Clin Anesth. 2004;16:111–6
2.Goodwin, C. R. et al (2011). Prevention of facial pressure ulcers using the Mayfield clamp. Journal of Neurosurgery. 14(1), 85-87.
3.Grisell M,. Face tissue pressure in prone positioning: A comparison of three face pillows while in prone position. Spine 2007;7(5):84S–85S.
4.McMichael, JC, Place, HM,. Face Tissue Pressures in Prone Positioning: A Comparison of 3 Pillows. Journal of Spinal Disorders & Techniques 2008; 21(7), 508-513.