Prevalence and incidence of pressure injury in adult patients receiving non-invasive ventilation for acute respiratory failure: a systematic review and meta-analysis protocol

Objective: This systematic review aims to assess the prevalence and incidence of pressure injury associated with non-invasive ventilation (NIV) in adult patients treated for acute respiratory failure (ARF). Introduction: Facial pressure sores are a common complication of NIV, impairing skin integrity, patient comfort, and therapy efficacy. However, the ranges of incidence and prevalence reported in the literature are very wide. Eligibility criteria: This review will include analytical observational and experimental studies reporting prevalence and/or incidence of pressure sores in adults treated with NIV for hypoxemic or hypercapnic ARF using oronasal, full-face, or hybrid masks. Any study or study arm testing interventions to reduce pressure sores will be excluded. Studies on pediatric patients and adult patients treated with other interfaces (ie, helmets) will also be excluded. Methods: This systematic review will be conducted in accordance with the JBI and PERSyst methodology for systematic reviews of prevalence and incidence. Searches will be conducted in PubMed, Cochrane Library, Web of Science, Embase, national health-agency surveillance systems, Centers for Disease Control and Prevention data, gray literature, and clinical trial registers to identify unpublished studies. No language limitations will be applied provided an English abstract is available. Two reviewers will independently select studies, and data will be extracted using a customized form. Narrative synthesis will be conducted and, where appropriate, pooled prevalence and incidence proportion will be calculated using the DerSimonian and Laird method. Methodological quality will be assessed using JBI's Critical Appraisal Tool for Prevalence and Incidence Studies. Review registration: PROSPERO CRD42024604191.