Pressure Injury Occurrence with Prone Position, Fever, Total Body Water, Sweat and Expansion

Introduction: Prone positioning in ARDS can improve ventilation. Its use in the prevention for pressure injury (PI) has been debated. Development of PI has been found in older men, low weight, low Braden score, ICU stay, comorbidities and organ support. Our research was to characterize proned cases and determine factors including hydration and temperature affect risk for development of PI.Methods: IRB approval at Northwell Health for this retrospective study obtained. A cohort of acute respiratory distress cases from 2015- 2022 (n=60), retrieved by electronic medical record were matched (Braden score, age, gender, race, and BMI), with a 1:2 prone ratio    to examine the development, factors and outcome associated with PI. Retrospective review of inpatient history, labs (admission serum sodium (Na) and fluid intake was done. Calculation of admission lean body weight1 , Na and body surface area (BSA), was used to determine total body water (TBW)deficit (L/sqm). Radius((r0) was obtained (equalizing spherical surface area (12.56r2) to BSA on admit). The rmax   value was computed from admit weight + highest daily Input (L) recorded. Fever (temperature >99.6F) was quantified by days and T points (1T point /1’Fdegree elevation). Insensible fluid loss (IFL) (2.5ml/kg/’F) was determined using highest temperature recorded each febrile day. Statistics included Pearson Chi squared test, Wilcoxon rank sum, and Wilcoxon rank sum testResults: The cohort (average age 62.8 years, BMI 28.7, Braden score 16.23), had similar PI rates among genders (n=14, 23.33%). PI were identified on trunk (10), extremity (5) and facial (2) skin, with mostly deep tissue injury (DTI) and stage II types (n=6 each, respectively), in longer LOS cases (median 26.5d, p