Pressure Injury Risks with Head and Neck Positioning for Severe Burn Injury Patients in the Intensive Care Setting

Ms Akane Katsu1, Miss Tanya Iddamalgoda1, Mr Iain Brown2, Miss Kate Welsh3, Ms Rachel Edmondson4, Ms Julie Bricknell4, Mr Matt Tinker5

1Occupational Therapy Department, Royal North Shore Hospital, St Leonards, Australia, 2Assistive Technology & Seating, Northern Sydney Local Health District, North Ryde, Australia, 3Severe Burn Injury Unit, Royal North Shore Hospital, St Leonards, 2065, 4Physiotherapy Department, Royal North Shore Hospital, St Leonards, Australia, 5Intensive Care Unit, Royal North Shore Hospital, St Leonards, Australia


The inherent risk of pressure injuries for severe burn injury patients begins from the time of their admission into intensive care. Areas such as the occiput, frontal eminence, mental protuberance and ear are most at risk of pressure injury in patients who have significant head and neck burns. A plethora of contributing factors make it challenging to prevent pressure injuries, however, there are risk factors unique to severe burn patients (Gordon et al., 2004, Lewis et al., 2012, Maguina and Kirkland-Walsh, 2014). These include: presence of burn oedema, immobility, sedation, use of vasoactive medications, the use of splints and devices, the integrity of the burn injured skin itself, positioning of the head and neck and concomitant spinal injuries. A series of such injuries in our population prompted our burns team to investigate and review our clinical practice, which includes the use of a neck extension pillow. In the process of auditing our clinical protocol for head and neck positioning post burn injury; we also undertook pressure mapping to establish baseline measurements for our current patients.
This paper will present our findings and recommendations for a prospective study into pressure injury prevention in severe burn injury patients with head and neck burns who require head and neck positioning for the prevention of burn contracture.

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LEWIS, G. M., PHAM, T. N., ROBINSON, E., OTTO, A., HONARI, S., HEIMBACH, D. M., KLEIN, M. B. & GIBRAN, N. S. 2012. Pressure ulcers and risk assessment in severe burns. Journal of Burn Care & Research, 33, 619-23.
MAGUINA, P. & KIRKLAND-WALSH, H. 2014. Hospital-acquired pressure ulcer prevention: a burn surgeon’s team approach. Journal of Burn Care & Research, 35, e287-93.


Akane Katsu is the Senior Burns Occupational Therapist at the Severe Burn Injury Unit, Royal North Shore Hospital. Her interests are in recovery outcomes, complex burn injuries and scar management.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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