key: cord-0858687-fpbz7143
authors: Ramondetta, Alice; Ribero, Simone; Costi, Sonia; Dapavo, Paolo
title: Pression‐induced facial ulcers by prone position for COVID‐19 mechanical ventilation
date: 2020-06-03
journal: Dermatol Ther
DOI: 10.1111/dth.13748
sha: f54ff316cc17e9bc6047fdda2ba37dba7f0b3d72
doc_id: 858687
cord_uid: fpbz7143

nan

Dear Editor, Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), now widespread throughout the world, is responsible for causing extremely variable clinical situations, from asymptomatic or paucisymptomatic forms to serious cases of pneumonia complicated by Acute Respiratory Distress Syndrome (ARDS), whose prevalence among COVID-19 patients is up to 17% 1 .

For the airway management in case of moderate to severe ARDS, several mechanical ventilation techniques have been adopted, including the prone position 2 , which has proven to be useful for improving ventilation-perfusion matching 3 , increasing end-expiratory lung volume 4 , and preventing ventilator-induced lung injury. In fact, this method, if used for at least 12 hours a day, has been shown to reduce mortality. Nevertheless, at the same time, it is associated with an increased risk of endotracheal tube obstruction and pressure sores [5] [6] . In relation to the latter, we describe the case of a patient hospitalized for COVID-19 and subjected to mechanical ventilation in prone position, who developed pressure ulcers on the face.

Our aim is to further enrich the literature related to the current Coronavirus pandemic in order to have as much information as possible for an optimal management of these patients.

On 12 March, a 48-year-old man, in good general health except for previous episodes of tachycardia for which he was taking beta-blockers, developed the first symptoms such as fever subsequently accompanied by dyspnoea,. Therefore, on 18 March he was hospitalized, where COVID-19 interstitial bilateral pneumonia was diagnosed by nasopharyngeal swab and chest X-ray. After 5 days, his clinical condition was worsening and the respiratory insufficiency increasing, evolving towards ARDS. Continuous Positive Airway Pressure (CPAP) used so far was no longer sufficient and he underwent tracheal intubation and was This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved. 

This article is protected by copyright. All rights reserved.

Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: a descriptive study

Prone Position in Management of COVID-19 Patients; a Commentary. Arch Acad Emerg Med

Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome

Improved oxygenation in patients with acute respiratory failure: the prone position

Prone position for acute respiratory distress syndrome: A systematic review and meta-analysis Ann Am Thorac Soc 14

1 Marco Ghiglione,1 Marianna Pesce,1 Ileana Orejuela,1 Silvia Scarrone, 2 and Renzo Panizza1 Facial Pressure Ulcers in a COVID-19 50-year-old Female Intubated Patient