Upper limb peripheral nerve injuries in patients with ARDS requiring prone positioning: A systematic review with proportion meta-analysis

• Published in: Intensive & critical care nursing Vol. 85; p. 103766
• Main Authors: Binda, Filippo, Gambazza, Simone, Marelli, Federica, Rossi, Veronica, Lusignani, Maura, Grasselli, Giacomo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2024; Elsevier Limited
• Subjects: Airway management; Arms; Bias; Brachial plexus; Brachial plexus neuropathies; Clinical medicine; Clinical training; Content analysis; COVID-19; COVID-19 - complications; Electromyography; Epidemiology; Health care; Humans; Injuries; Intensive care; Intensive care units; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Interdisciplinary aspects; Limbs; Magnetic resonance imaging; Medical Subject Headings-MeSH; Meta-analysis; Multidisciplinary teams; Observational studies; Pandemics; Patient admissions; Patient positioning; Patient Positioning - methods; Patient satisfaction; Peripheral nerve injuries; Peripheral Nerve Injuries - etiology; Peripheral neuropathy; Positioning; Prevention; Prone; Prone Position; Psychological distress; Quantitative analysis; Respiratory distress syndrome; Respiratory Distress Syndrome - etiology; Software; Systematic review; Upper Extremity - injuries; Upper Extremity - physiopathology; Ventilators; COVID-19; Peripheral nerve injuries; Prone position; Intensive care units; Respiratory distress syndrome; Brachial plexus neuropathies
• DOI: 10.1016/j.iccn.2024.103766
• ISSN: 0964-3397; 1532-4036

To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning. This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning. A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I2 = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies. During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations. Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.