Table_1_Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study.DOCX

BackgroundAlthough the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking.
ProposeTo conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit.
MethodsThe study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method.
ResultsAfter two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall’s coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall’s coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies.
ConclusionAccording to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.

背景 尽管重症监护病房（intensive care unit, ICU）内接受机械通气的俯卧位患者压力性损伤（pressure injury）发生率较高，但目前仍缺乏基于证据的防控策略。
研究目的 本研究拟对现有证据开展系统综述，并针对重症监护病房内俯卧位机械通气患者制定一系列压力性损伤防控策略。
研究方法 本研究遵循医学研究理事会（Medical Research Council）框架开展。首先对原始研究、指南、专家共识及相关理论的现有证据进行系统综述，形成策略草案；随后邀请20名专家通过两轮德尔菲（Delphi）共识法对该草案进行修改与完善。
研究结果 经两轮德尔菲流程后，策略库中变异系数（coefficient of variation, Cv）与肯德尔协调系数（Kendall’s coefficient of concordance）的重要性得分分别为0.067和0.311；策略草案的可操作性维度中，变异系数与肯德尔协调系数的对应得分分别为0.055和0.294。最终本研究确立了涵盖7大主题的31项防控策略，主题包括：风险因素评估、皮肤与组织评估、体位管理、皮肤护理、营养支持、预防医疗设备相关性压力性损伤、教育与监督。此外，本研究还构建了策略框架以明确各项策略的逻辑层级。
研究结论 本研究遵循医学研究理事会框架，针对重症监护病房俯卧位机械通气患者制定了7大主题共31项压力性损伤防控策略。本研究可优化重症监护病房内俯卧位患者的压力性损伤临床管理工作。