By Skin vs. Breath: How to Prevent Pressure Injuries While Keeping Lungs Clear
By Dr. Mike at Joerns
Introduction: Balancing Respiratory Health and Skin Integrity
Caregivers and healthcare providers often face the challenge of ensuring proper respiratory support while also preventing pressure injuries. Patients with compromised lung function may require elevated head positioning, but prolonged elevation can increase pressure risks, especially in the sacral region. Striking the right balance between lung expansion and skin protection is crucial for improving patient outcomes.
The Respiratory-Skin Connection
Patients requiring respiratory support, such as those with pneumonia, COPD, or recovering from severe flu, benefit from elevated head-of-bed positioning. However, prolonged elevation beyond 30 degrees can place excessive pressure on the sacrum and heels, increasing the likelihood of pressure injuries.
To address this, caregivers must implement strategies that support both respiratory function and skin integrity without compromising either.
Best Practices for Maintaining Lung Health
Proper lung function depends on effective positioning that allows for optimal airway expansion and oxygen exchange. Some key techniques include:
- Head-of-Bed Elevation (30-45 Degrees): Helps reduce aspiration risk and promotes lung expansion.
- Frequent Position Adjustments: Shifting patient positioning helps avoid prolonged pressure on any one area.
- Use of Therapeutic Support Surfaces: Dynamic air systems can help redistribute pressure.
- Encouraging Deep Breathing Exercises: Patients who can actively participate should practice breathing exercises to support lung function.
Preventing Pressure Injuries in Elevated Patients
Preventing pressure injuries while maintaining lung health requires a proactive approach that includes:
- Repositioning Schedule: Patients should be repositioned often with the common thought of at least every two hours to redistribute pressure.
- Heel and Sacral Pressure Relief: Use pressure-redistributing cushions, boots, or offloading devices.
- Microshifting Techniques: Small, frequent shifts in body weight can alleviate pressure without compromising lung function.
- Skin Inspections: Regularly check for early signs of pressure injuries, such as redness or blanching, especially in high-risk areas.
Technology and Equipment to Support Both Needs
Innovative medical equipment can help caregivers address both respiratory and skin health needs. Solutions include:
- Adjustable Hospital Beds: Beds with integrated pressure redistribution and adjustable angles provide flexibility.
- Fluidized Therapy Beds: These beds reduce interface pressure while maintaining comfort in elevated positions.
- Turn Assist Features: Some advanced beds assist caregivers with repositioning patients while maintaining necessary elevation.
Empowering Caregivers with Knowledge
Caregivers should be trained in recognizing the early warning signs of respiratory distress and pressure injuries. Key educational strategies include:
- Hands-on Training Sessions: Practical learning for proper patient positioning and support.
- Use of Technology for Monitoring: Some support surfaces include pressure-mapping tools to guide positioning.
- Collaboration with Wound Care and Respiratory Teams: A multidisciplinary approach ensures comprehensive care.
Conclusion: Finding the Right Balance
Providing high-quality care means recognizing that both respiratory health and skin integrity must be prioritized simultaneously. Through thoughtful positioning, assistive technologies, and caregiver education, it is possible to optimize patient outcomes while preventing complications.
