The COVID-19 pandemic resulted in a surge of patients with acute severe respiratory failure who required mechanical ventilation (Docherty et al., 2020). For these patients, early prone positioning was associated with improved oxygenation and patient survival (Mathews et al., 2021, Camporota et al., 2022). Use of prone positioning has become widespread and large prospective cohort studies of mechanically ventilated COVID-19 patients report proning rates as high as 70 % (Kharat et al., 2022). However, previous proning studies have also brought attention to the high incidence of anterior pressure injuries associated with prolonged and repeated prone positioning (Girard et al., 2014, Lucchini et al., 2020).

The early literature on proning during the COVID-19 pandemic demonstrated varying incidences of such pressure injuries ranging from 21 % to 88 % (Ibarra et al., 2021, Astua et al., 2021, Shearer et al., 2021, Douglas et al., 2021, Challoner et al., 2022). This wide range of incidences may, in part, be due to differences in patient positioning, application of prophylactic dressings and frequency of pressure area care in the prone position (Deschepper et al., 2022). Currently, there is no clear optimal prone position technique to minimise pressure injuries (Intensive Care Society, 2019). Furthermore, studies following up these pressure injuries beyond patients’ intensive care unit (ICU) stay are also lacking (Elmer et al., 2023).

Accordingly, our multidisciplinary ICU team conducted a study to ascertain differences in the incidence and anatomical distribution of pressure injuries with two prone positions for mechanically ventilated COVID-19 patients – the ‘Face Down’ position and the ‘Swimmers Position’. We also sought to determine the prevalence of these pressure injuries on ICU and hospital discharge.