Tolerating the turn: Can an alternative pillow solution offer better pressure redistribution during prone positioning?

Abstract

Aims Effective pressure management and comfort during prone positioning are core to patient tolerance minimising the need for enhanced respiratory support techniques such as mechanical ventilation. This study explored the impact of a new (low-tech) pillow solution on interface pressure and comfort during prone positioning compared to standard hospital solutions. Methods In this healthy cohort, within-subject comparative study, person-surface interface pressures were calculated for three different conscious prone positioning methods (a standard hospital pillow at the head (HPO), a three-pillow standard hospital proning solution (3HP), and a new two-pillow prone positioning solution (NPP) with additional standard head pillow). Written informed consent was obtained prior to participation. Contact surface area, peak and mean pressure, Peak Pressure Index (PPI) (head, trunk, pelvis, legs), and subjective comfort were calculated for all conditions over a 21-minute period.

Results Twenty healthy volunteers took part in this study. The new alternative prone positioning solution lowered PPI at the trunk compared to standard pillow proning (p<0.017) and proning with head support only (p<0.001). The alternative solution also significantly reduced head PPI compared to lying with only a head support. Both pillow proning conditions significantly improved comfort compared to proning with a head support only.

Conclusion Overall, improved pressure management and comfort was noted for the alternative prone positioning kit, compared to existing solutions, suggesting a low-tech alternative to improving tolerance and adherence of patient prone positioning.