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Hlebichuk J, Buck E, Brooker AL, Mackenzie JK, Cleary MB, Singh M, Hook M. Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries. Dimens Crit Care Nurs 2024; 43:246-252. [PMID: 39074228 DOI: 10.1097/dcc.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs). OBJECTIVES To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest. METHOD This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression. RESULTS The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03). DISCUSSION Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.
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Woolger C, Rollinson T, Oliphant F, Ross K, Ryan B, Bacolas Z, Burleigh S, Jameson S, McDonald LA, Rose J, Modra L, Costa-Pinto R. Pressure injuries in mechanically ventilated COVID-19 patients utilising different prone positioning techniques - A prospective observational study. Intensive Crit Care Nurs 2024; 82:103623. [PMID: 38215559 DOI: 10.1016/j.iccn.2024.103623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To compare the incidence and distribution of pressure injuries (PIs) with two approaches to prone positioning for mechanically ventilated COVID-19 patients, and to determine the prevalence of these PIs on intensive care unit (ICU) and hospital discharge. DESIGN A prospective observational study. SETTING Adult patients admitted to a quaternary ICU with COVID-19-associated acute lung injury, between September 2021 and February 2022. MAIN OUTCOME MEASURES Incidence and anatomical distribution of PIs during ICU stay for "Face Down" and "Swimmers Position" as well as on ICU and hospital discharge. RESULTS We investigated 206 prone episodes in 63 patients. In the Face Down group, 26 of 34 patients (76 %) developed at least one PI, compared to 10 of 22 patients (45 %) in the Swimmers Position group (p = 0.02). Compared to the Swimmers Position group, the Face Down group developed more pressure injuries per patient (median 1 [1, 3] vs 0 [0, 2], p = 0.04) and had more facial PIs (p = 0.002). In a multivariate logistic regression model, patients were more likely to have at least one PI with Face Down position (OR 4.67, 95 % CI 1.28, 17.04, p = 0.02) and greater number of prone episodes (OR 1.75, 95 % CI 1.12, 2.74, p = 0.01). Over 80 % of all PIs were either stage 1 or stage 2. By ICU discharge, 29 % had healed and by hospital discharge, 73 % of all PIs had healed. CONCLUSION Swimmers Position had a significantly lower incidence of PIs compared to the Face Down approach. One-quarter of PIs had healed by time of ICU discharge and three-quarters by time of hospital discharge. IMPLICATIONS FOR CLINICAL PRACTICE There are differences in incidence of PIs related to prone positioning approaches. This study validates and helps better inform current prone position guidelines recommending the use of Swimmers Position. The low prevalence of PIs at hospital discharge is reassuring.
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Affiliation(s)
- Cara Woolger
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Thomas Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Department of Physiotherapy, the University of Melbourne, Parkville, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Fiona Oliphant
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Kristy Ross
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Brooke Ryan
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Zoe Bacolas
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Sarah Burleigh
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Stephanie Jameson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Department of Physiotherapy, the University of Melbourne, Parkville, Victoria, Australia
| | - Luke A McDonald
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Joleen Rose
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Lucy Modra
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia.
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Wang J, Jing J, Zhou C, Fan Y. Emerging roles of exosomes in oral diseases progression. Int J Oral Sci 2024; 16:4. [PMID: 38221571 PMCID: PMC10788352 DOI: 10.1038/s41368-023-00274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Oral diseases, such as periodontitis, salivary gland diseases, and oral cancers, significantly challenge health conditions due to their detrimental effects on patient's digestive functions, pronunciation, and esthetic demands. Delayed diagnosis and non-targeted treatment profoundly influence patients' prognosis and quality of life. The exploration of innovative approaches for early detection and precise treatment represents a promising frontier in oral medicine. Exosomes, which are characterized as nanometer-sized extracellular vesicles, are secreted by virtually all types of cells. As the research continues, the complex roles of these intracellular-derived extracellular vesicles in biological processes have gradually unfolded. Exosomes have attracted attention as valuable diagnostic and therapeutic tools for their ability to transfer abundant biological cargos and their intricate involvement in multiple cellular functions. In this review, we provide an overview of the recent applications of exosomes within the field of oral diseases, focusing on inflammation-related bone diseases and oral squamous cell carcinomas. We characterize the exosome alterations and demonstrate their potential applications as biomarkers for early diagnosis, highlighting their roles as indicators in multiple oral diseases. We also summarize the promising applications of exosomes in targeted therapy and proposed future directions for the use of exosomes in clinical treatment.
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Affiliation(s)
- Jiayi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Junjun Jing
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chenchen Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Fan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Gabiatti D, Vieira LG, Margatho AS, Dos Santos BN, Clark AM, Vasques CI, Silveira RCDCP. Prevalence of adverse events in pronated intubated adult COVID-19 patients: A systematic review with meta-analysis. J Clin Nurs 2024; 33:58-75. [PMID: 37149845 DOI: 10.1111/jocn.16741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
AIM To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients. DESIGN A systematic review and meta-analysis. DATA SOURCES This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources. METHODS The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%). CONCLUSION The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction. IMPLICATIONS FOR THE PATIENT CARE The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients. IMPACT This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units. REPORTING METHOD This systematic review adhered to the PRISMA reporting guideline. PATIENT OR PUBLIC CONTRIBUTION As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.
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Affiliation(s)
- Daiane Gabiatti
- Ribeirão Preto Nursing School, University of São Paulo, Ribeirão Preto - SP, Brazil
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Shawky MA, Shawky MA, Zakaria Zakaria N. Incidence of Airway Complications in ICU. Indian J Otolaryngol Head Neck Surg 2023; 75:2752-2759. [PMID: 37974766 PMCID: PMC10645749 DOI: 10.1007/s12070-023-03850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 11/19/2023] Open
Abstract
To show the incidence of airway complications in ICU. Endotracheal intubation is an essential skill performed by multiple medical specialists to secure a patient's airway as well as provide oxygenation and ventilation through the oral route or nose. The goal of endotracheal intubation in the emergency setting is to secure the patient's airway and obtain first-pass success. There are many indications for endotracheal intubation, including poor respiratory drive, questionable airway patency, hypoxia, and Hypercapnia. These indications are assessed by evaluating the patient's mental status, conditions that may compromise the airway, level of consciousness, respiratory rate, respiratory acidosis, and level of oxygenation. In the setting of trauma, a Glasgow Coma Scale of 8 or less is generally an indication for intubation. There are many different complications of intubation as hoarseness of voice, dental injuries, arytenoid dislocation, laryngeal stenosis, tracheal stenosis and tracheomalacia. . 150 patients who were sat in the ICU that developed certain complications. 86 patients (57.3%) were sitting in the ICU develoed certain complications. Liver diseases were the main cause of ICU admission 34 (22.7%) patients then shock 32 (21.3%) patients. Blockage of endotracheal tube was the main ICU complications 18 (12%) patients then sinusitis 16 (10.7%) patients. Endotracheal intubation is a lifesaving procedure and its complications are significant problems in ICUs. A successful procedure of intubation avoids complications. Skilled endotracheal intubation in the ICU decreases the complications.
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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Hughes PJ. Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit. J Wound Ostomy Continence Nurs 2023; 50:458-462. [PMID: 37966074 DOI: 10.1097/won.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE The purpose of this quality improvement (QI) initiative was to evaluate the effects of a repositioning intervention bundle on the occurrences and severity of hospital-acquired pressure injuries (HAPIs) of the face in patients with COVID-19-related acute respiratory distress syndrome (ARDS) managed by ventilation and placed in a prone position. PARTICIPANTS AND SETTING Eighteen critically ill, ventilated patients were placed in a prone position for extended periods (range, 1-13 days). The study setting was critical care units in a 504-bed nonprofit teaching hospital located in the Northeastern United States. APPROACH Standard of care for the prevention of pressure injury (PI) in ventilated patients placed in a prone position at our facility included use of foam dressings over bony prominences on the face and the application of tape to secure the endotracheal (ET) tube as compared to commercial ET tube securement devices. We also placed a fluidized pillow with pillowcase wrapped with an absorbent pad under the head to absorb secretions. We added 2 interventions to our facility's existing HAPI prevention bundle. The first was a repositioning strategy; ventilated and prone patients were lifted by their shoulders by critical care RNs while their ET tube was stabilized by a respiratory therapist every 6 hours. The RNs then repositioned the patient's head and arms to the opposite side into a swimmer's position (head lying to the side with one cheek in contact with the fluidized pillow). The second intervention was micromovement of the head performed by an RN every 4 hours. OUTCOMES Prior to implementation of the QI initiative, data collected during the early pandemic demonstrated that multiple patients developed facial PIs secondary to prone positioning; a majority were full-thickness or unstageable PIs, whereas a minority were partial-thickness PIs (stage 2). Following implementation of the QI initiative, data indicated that 5 of 18 (28%) patients placed in a prone position had HAPIs of the face; 4 (22%) of the HAPIs were stage 1 or 2 and 1 was unstageable. Patients were placed in a prone position from 1 to 13 days. All facial HAPIs developed within the first 2 days of placement in a prone position. IMPLICATIONS FOR PRACTICE The addition of an RN and a respiratory therapist repositioning intervention and micromovements of the head every 4 hours by the RN to an existing pressure prevention bundle during prone positioning led to a clinically relevant reduction in the severity of facial HAPIs. As a result, care for these patients has been changed to incorporate the repositioning interventions implemented during this QI project.
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Affiliation(s)
- Pamela J Hughes
- Pamela J. Hughes, MSN, MBA, RN, CWOCN, CNL, Overlook Medical Center, Westfield, New Jersey
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Pérez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gómez-Arroyo JM, Sáez-Romero D, Ortiz-Monjo A. Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19. ENFERMERIA INTENSIVA 2023; 34:176-185. [PMID: 37248133 PMCID: PMC10201329 DOI: 10.1016/j.enfie.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 05/31/2023]
Abstract
The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.
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Affiliation(s)
- E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Comarcal de Manacor, Manacor, Spain; Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain.
| | - M Maqueda-Palau
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain; Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Spain
| | | | | | - D Sáez-Romero
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
| | - A Ortiz-Monjo
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
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Karavidas N, Paraskeva I, Zakynthinos GE, Tsolaki V. Enterocutaneous Fistula in a COVID-19 Obese Patient During Prolonged Prone Position for Severe Acute Respiratory Distress Syndrome. Cureus 2023; 15:e47212. [PMID: 38021961 PMCID: PMC10653124 DOI: 10.7759/cureus.47212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Prone position (PP) has been widely used in patients under mechanical ventilation for COVID-19 acute respiratory distress syndrome (ARDS), usually for many hours per day. Complications are not rare, although most of them are mild. To our knowledge, we report the first case of enterocutaneous fistula after prolonged use of PP in the literature. Morbid obesity; yielding increased abdominal wall pressure when the patient was prone; pre-existing intestinal hernias; and increased vasopressor doses for septic shock due to secondary infections resulted in necrosis of the small intestine, the abdominal wall, and the skin leading to enterocutaneous fistula. Clinicians managing patients with COVID-19 should keep in mind this complication, especially when proning obese patients with a history of intestinal surgery, as the presence of intestinal hernias might be missed during a clinical examination.
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Affiliation(s)
- Nikitas Karavidas
- Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
| | | | | | - Vasiliki Tsolaki
- Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
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Desselle MR, Coyer F, Byram I, Fakhr R, Forrestal DP, Green N, Mason O, Wainwright L, Kirrane M. Safety and usability of proning pillows in intensive care: A scoping review. Aust Crit Care 2023; 36:847-854. [PMID: 37616086 DOI: 10.1016/j.aucc.2022.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Proning is an established technique for the care of intubated patients with severe respiratory failure. Positioning devices used to support the head and body of patients placed in the prone position are often associated with the formation of pressure injuries. Despite robust literature on the prevention and monitoring of pressure injuries, little is described about the role of proning pillows on pressure injuries. The objective of this review is to understand the extent of evidence pertaining to the safety and usability of different types of proning pillows in the intensive care setting. REVIEW METHOD A scoping review of the literature was completed using predefined search terms in three databases and identified 296 articles. An additional 26 were included from reference lists. Twenty studies are included in the analysis; most were published in the past 3 years, with >50% in surgical settings. DATA SOURCES Three databases were searched: PubMed, Scopus, and EMBASE. REVIEW METHODS The review followed the PRISMA Extension for Scoping Reviews, and data were reviewed using Covidence. RESULTS The most prevalent proning pillow is a standard, noncontoured foam head positioner. It is responsible for the majority of facial pressure injuries in all settings of care. Memory foam pillows and helmet-based systems offer improved surface pressure distribution, although their usability in the intensive care setting remains poorly studied. Inflatable air-cell-based devices present an alternative, but the lack of supporting research and the costs may explain their poor uptake. Several articles proposed the use of pressure sensor systems to evaluate devices. We propose a set of ergonomic parametres to consider when choosing or designing a positioning device for proned patients. CONCLUSION The evidence pertaining to the safety and usability of proning pillows in the intensive care setting is scarce, which provides opportunities for future research to improve the efficacy in the prevention of pressure injuries and the user experience.
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Affiliation(s)
- Mathilde R Desselle
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; Faculty of Engineering, Queensland University of Technology, Brisbane QLD 4000 Australia; School of Medicine, The University of Queensland, Herston QLD 4006 Australia.
| | - Fiona Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029 Australia; School of Nursing, Queensland University of Technology, Kelvin Grove QLD 4059 Australia
| | - Isabel Byram
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia
| | - Roozbeh Fakhr
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; Faculty of Creative Industries, Education and Social Justice, Queensland University of Technology, Kelvin Grove QLD 4059 Australia
| | - David P Forrestal
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; School of Mechanical and Mining Engineering, The University of Queensland, St Lucia QLD 4067 Australia
| | - Nicholas Green
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia
| | - Oliver Mason
- Rehabilitation Engineering Centre, Surgical Treatment and Rehabilitation Services, Herston QLD 4029 Australia
| | - Luke Wainwright
- Clinical Skills Development Service, Herston QLD 4029 Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia QLD 4072 Australia
| | - Marianne Kirrane
- School of Medicine, The University of Queensland, Herston QLD 4006 Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029 Australia
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Melo CMD, Bueno ADLG, Rossetto TL, Almeida BGD, Moretto LB, Diniz MBC. Pressure Injury in Intensive Care Unit: prevalence and associated factors in patients with COVID-19. Rev Gaucha Enferm 2023; 44:e20210345. [PMID: 37341281 DOI: 10.1590/1983-1447.2023.20210345.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/05/2022] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE To determine the frequency of pressure injuries and identify associated risk factors in patients affected by COVID-19 admitted to an intensive care unit. METHOD Cross-sectional, retrospective study with a quantitative approach carried using a documentary research. The sample included 393 medical records that were in accordance with our inclusion criteria, selected from March 2020 to March 2021 in a hospital in the south of Brazil. Data were analyzed using descriptive statistics in the software Bioestat 5. RESULTS The prevalence of pressure injuries in COVID-19 patients was 42%, the risk factors associated with these injuries were hospitalization time, ventilation treatment, and staying in the prone position, all with a significance of p<0.05. CONCLUSION Patients with COVID-19 are subject to several unmodifiable factors that are determinant for the appearance of pressure injuries. Therefore, preventive measures should be rigorously applied to this population.
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Affiliation(s)
- Camila Mumbach de Melo
- Hospital de Clínicas de Passo Fundo (HCPF), Programa de Residência Multiprofissional em Urgência Emergência e Intensivismo. Passo Fundo, Rio Grande do Sul, Brazil
| | - Ariane de Lourdes Gomes Bueno
- Hospital de Clínicas de Passo Fundo (HCPF), Programa de Residência Multiprofissional em Urgência Emergência e Intensivismo. Passo Fundo, Rio Grande do Sul, Brazil
| | - Taís Loticci Rossetto
- Hospital de Clínicas de Passo Fundo (HCPF), Programa de Residência Multiprofissional em Urgência Emergência e Intensivismo. Passo Fundo, Rio Grande do Sul, Brazil
| | - Brenda Girardi de Almeida
- Hospital de Clínicas de Passo Fundo (HCPF), Programa de Residência Multiprofissional em Urgência Emergência e Intensivismo. Passo Fundo, Rio Grande do Sul, Brazil
| | - Liliane Becker Moretto
- Hospital de Clínicas de Passo Fundo (HCPF), Programa de Residência Multiprofissional em Urgência Emergência e Intensivismo. Passo Fundo, Rio Grande do Sul, Brazil
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Sandhu J, Miller C, Kapp S. Characteristics of COVID-19 patients who developed pressure injuries: a scoping review. J Wound Care 2023; 32:S9-S16. [PMID: 36930283 DOI: 10.12968/jowc.2023.32.sup3.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
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Affiliation(s)
- Julie Sandhu
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
| | - Charne Miller
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
- School of Nursing & Midwifery, La Trobe University, Melbourne, Australia
| | - Suzanne Kapp
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
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Elmer N, REIßHAUER A, Brehm K, Vockeroth C, Liebl ME. Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature. Eur J Phys Rehabil Med 2023; 59:111-121. [PMID: 36441010 PMCID: PMC10035441 DOI: 10.23736/s1973-9087.22.07529-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions (i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.
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Affiliation(s)
- Nancy Elmer
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany -
- Humboldt University of Berlin, Berlin, Germany -
| | - Anett REIßHAUER
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Katharina Brehm
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Clarissa Vockeroth
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Max E Liebl
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
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15
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Rubulotta F, Brett S, Boulanger C, Blackwood B, Deschepper M, Labeau SO, Blot S. Prevalence of skin pressure injury in critical care patients in the UK: results of a single-day point prevalence evaluation in adult critically ill patients. BMJ Open 2022; 12:e057010. [PMID: 36418122 PMCID: PMC9685232 DOI: 10.1136/bmjopen-2021-057010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Hospital-acquired pressure injuries (PIs) are a source of morbidity and mortality, and many are potentially preventable. DESIGN This study prospectively evaluated the prevalence and the associated factors of PIs in adult critical care patients admitted to intensive care units (ICU) in the UK. SETTING This service evaluation was part of a larger, international, single-day point prevalence study of PIs in adult ICU patients. Training was provided to healthcare givers using an electronic platform to ensure standardised recognition and staging of PIs across all sites. PARTICIPANTS The characteristics of the ICUs were recorded before the survey; deidentified patient data were collected using a case report form and uploaded onto a secure online platform. PRIMARY AND SECONDARY OUTCOME MEASURES Factors associated with ICU-acquired PIs in the UK were analysed descriptively and using mixed multiple logistic regression analysis. RESULTS Data from 1312 adult patients admitted to 94 UK ICUs were collected. The proportion of individuals with at least one PI was 16% (211 out of 1312 patients), of whom 8.8% (n=115/1312) acquired one or more PIs in the ICU and 7.3% (n=96/1312) prior to ICU admission. The total number of PIs was 311, of which 148 (47.6%) were acquired in the ICU. The location of majority of these PIs was the sacral area, followed by the heels. Braden score and prior length of ICU stay were associated with PI development. CONCLUSIONS The prevalence and the stage of severity of PIs were generally low in adult critically ill patients admitted to participating UK ICUs during the study period. However, PIs are a problem in an important minority of patients. Lower Braden score and longer length of ICU stay were associated with the development of injuries; most ICUs assess risk using tools which do not account for this. TRIAL REGISTRATION NUMBER NCT03270345.
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Affiliation(s)
- Francesca Rubulotta
- Intensive Care Medicine, McGill University, Montreal, Quebec, Canada
- Montreal General Hospital, Montreal, Quebec, Canada
- Anaesthetics and Intensive Care, Imperial College London, London, UK
| | - Stephen Brett
- Anaesthetics and Intensive Care, Imperial College London, London, UK
| | | | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | | | - Stijn Blot
- Ghent University Hospital, Ghent, Belgium
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Facial Pressure Sores in COVID-19 Patients during Prone Positioning: A Case Series and Literature Review. Plast Reconstr Surg Glob Open 2022; 10:e4610. [PMID: 36246073 PMCID: PMC9555603 DOI: 10.1097/gox.0000000000004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has been a source of several stays in intensive care units, increasing the number of prone positioning. In parallel, complications increased, such as facial ulcers. Herein, we present a literature review and a case series about facial pressure sores in COVID-19 patients during prone positioning. This study aimed to show that such facial pressure sores may require surgical intervention in specific cases.
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18
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Seckel MA, Mitchell DA. Securing Endotracheal Tubes During Prone Positioning. Crit Care Nurse 2022; 42:77-79. [PMID: 36180052 DOI: 10.4037/ccn2022354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Maureen A Seckel
- Maureen A. Seckel is a critical care clinical nurse specialist and sepsis coordinator, ChristianaCare, Newark, Delaware
| | - Dannette A Mitchell
- Dannette A. Mitchell is a medical critical care clinical nurse specialist, ChristianaCare, Wilmington, Delaware
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19
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Dantas AC, Costa ML, Silva ABD, Borges BEC, Araújo JNDM, Vitor AF. Eye Care Interventions in Critical/Surgical Patients in the Prone Position: Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute’s methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: “What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?” The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority.
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Weller CD, Turnour L, Connelly E, Banaszak-Holl J, Team V. Clinical Coders' Perspectives on Pressure Injury Coding in Acute Care Services in Victoria, Australia. Front Public Health 2022; 10:893482. [PMID: 35719639 PMCID: PMC9198603 DOI: 10.3389/fpubh.2022.893482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.
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Affiliation(s)
- Carolina Dragica Weller
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,*Correspondence: Carolina Dragica Weller
| | - Louise Turnour
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | | | - Jane Banaszak-Holl
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
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21
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Nghiem S, Campbell J, Walker RM, Byrnes J, Chaboyer W. Pressure injuries in Australian public hospitals: A cost of illness study. Int J Nurs Stud 2022; 130:104191. [PMID: 35436596 DOI: 10.1016/j.ijnurstu.2022.104191] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are a leading hospital adverse event, yet they are mostly preventable. Understanding their financial costs will help to appreciate the burden they place on the health system and assist in better planning and management of health expenditures to prevent pressure injuries. OBJECTIVE To estimate the cost of pressure injuries in Australian public hospitals in 2020 demonstrating its economic burden in a well-resourced health system. METHODS A cost of illness study with a 12-month time horizon was conducted. Resource use for the treatment of pressure injuries and productivity loss due to pressure injuries were derived using a bottom-up approach. Parameters of the cost estimates were obtained from secondary sources and literature syntheses. A simulation with 10,000 draws was used to generate statistical properties of the cost estimates. RESULTS Based on a prevalence of 12.9%, the total cost of pressure injuries in Australian public hospitals was $9.11 billion [95% confidence intervals: 9.02, 9.21]. The two largest shares of costs were accounted for by the opportunity cost of excess length of stay of $3.60 billion [3.52, 3.68] and treatment costs of $3.59 billion [3.57, 3.60]. Productivity loss associated with pressure injuries amounts to $493 million [482, 504]. Hospital-acquired pressure injuries account for a total of $5.50 billion [5.44, 5.56], whereas pressure injuries present on admissions costed $3.71 billion [3.70, 3.72]. In terms of severity, Stage 2 pressure injuries contributed the most to total treatment costs, total excessive length of stay, and total loss of healthy life years. Australian society is willing to pay $1.43 billion [1.40, 1.45] to save 6,701 [6,595; 6,807] healthy life years lost by pressure injury. CONCLUSIONS Reducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia and will likely have similar benefits for other countries with comparable profiles. TWEETABLE ABSTRACT Australian public hospital study provides comprehensive analysis of the cost of pressure injury, including estimates of direct and indirect medical costs, and indirect non-medical costs - such as productivity and quality of life.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia.
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care; Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Josh Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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22
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Hochberg CH, Psoter KJ, Sahetya SK, Nolley EP, Hossen S, Checkley W, Kerlin MP, Eakin MN, Hager DN. Comparing Prone Positioning Use in COVID-19 Versus Historic Acute Respiratory Distress Syndrome. Crit Care Explor 2022; 4:e0695. [PMID: 35783548 PMCID: PMC9243245 DOI: 10.1097/cce.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Use of prone positioning in patients with acute respiratory distress syndrome (ARDS) from COVID-19 may be greater than in patients treated for ARDS before the pandemic. However, the magnitude of this increase, sources of practice variation, and the extent to which use adheres to guidelines is unknown.
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23
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Madueño JM, Sayer L. Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S22-S32. [PMID: 35220748 DOI: 10.12968/bjon.2022.31.4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Many patients with COVID-19 admitted to intensive care undergo prone positioning. These patients are at risk of developing facial pressure ulcers (PUs). This study aimed to identify evidence-based recommendations to prevent or reduce their incidence. METHOD A multi-case study was undertaken using secondary data published between November 2020 and April 2021 discussing facial PUs in patients with COVID-19. CINAHL and MEDLINE electronic databases were analysed. Sixteen publications met the inclusion criteria. The overall quality of evidence was low. RESULT Studies reported a high incidence of facial PUs. The evidence suggests key preventive areas are skin assessment, pressure-redistribution surfaces, eye coverings, education, medical devices and prophylactic dressings. Recommendations included skin cleaning and moisturising, eye coverings, replacing endotracheal tube holders and using hydrocolloid or film dressings. CONCLUSION Considering the severe implications for patients and healthcare systems caused by facial PUs, ICUs should develop strategies to prevent and minimise them.
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Affiliation(s)
- Jaime Moreno Madueño
- Registered Nurse, at time of writing studying MSc Nursing with Registration as an Adult Nurse, King's College London
| | - Lynn Sayer
- Senior Lecturer, Department of Adult Nursing, King's College London
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25
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Orilisi G, Mascitti M, Togni L, Monterubbianesi R, Tosco V, Vitiello F, Santarelli A, Putignano A, Orsini G. Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312511. [PMID: 34886241 PMCID: PMC8656958 DOI: 10.3390/ijerph182312511] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/21/2022]
Abstract
Background: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. Methods: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. Results: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. Conclusions: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.
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Affiliation(s)
- Giulia Orilisi
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Marco Mascitti
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Lucrezia Togni
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Riccardo Monterubbianesi
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Vincenzo Tosco
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Flavia Vitiello
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Andrea Santarelli
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10, 60126 Ancona, Italy
| | - Angelo Putignano
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
| | - Giovanna Orsini
- Department of Clinical, Specialistic and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy; (G.O.); (M.M.); (L.T.); (R.M.); (V.T.); (F.V.); (A.S.); (A.P.)
- Correspondence: ; Tel.: +39-34-7248-3290
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Short and long-term complications due to standard and extended prone position cycles in CoViD-19 patients. Intensive Crit Care Nurs 2021; 69:103158. [PMID: 34895799 PMCID: PMC8554071 DOI: 10.1016/j.iccn.2021.103158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate short and long-term complications due to standard (≤24 hours) and extended (>24 hours) prone position in COVID-19 patients. METHODS Retrospective cohort study conducted in an Italian general intensive care unit. We enrolled patients on invasive mechanical ventilation and treated with prone positioning. We recorded short term complications from the data chart and long-term complications from the scheduled follow-up visit, three months after intensive care discharge. RESULTS A total of 96 patients were included in the study. Median time for each prone positioning cycle (302 cycles) was equal to 18 (16-32) hours. In 37 (38%) patients at least one cycle of extended pronation was implemented. Patients with at least one pressure sore due to prone position were 38 (40%). Patients with pressure sores showed a statistically significative difference in intensive care length of stay, mechanical ventilation days, numbers of prone position cycles, total time spent in prone position and the use of extended prone position, compared to patients without pressure sores. All lesions were low grade. Cheekbones (18%) and chin (10%) were the most affected sites. Follow-up visit, scheduled three months after intensive care discharge, was possible in 58 patients. All patients were able to have all 12 muscle groups examined using theMedical Research Council scale examination. No patient reported sensory loss or presence of neuropathic pain for upper limbs. CONCLUSIONS Extended prone position is feasible and might reduce the workload on healthcare workers without significant increase of major prone position related complications.
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Driver VR, Couch KS, Eckert KA, Gibbons G, Henderson L, Lantis J, Lullove E, Michael P, Neville RF, Ruotsi LC, Snyder RJ, Saab F, Carter MJ. The impact of the SARS-CoV-2 pandemic on the management of chronic limb-threatening ischemia and wound care. Wound Repair Regen 2021; 30:7-23. [PMID: 34713947 PMCID: PMC8661621 DOI: 10.1111/wrr.12975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023]
Abstract
In the wake of the coronavirus pandemic, the critical limb ischemia (CLI) Global Society aims to develop improved clinical guidance that will inform better care standards to reduce tissue loss and amputations during and following the new SARS‐CoV‐2 era. This will include developing standards of practice, improve gaps in care, and design improved research protocols to study new chronic limb‐threatening ischemia treatment and diagnostic options. Following a round table discussion that identified hypotheses and suppositions the wound care community had during the SARS‐CoV‐2 pandemic, the CLI Global Society undertook a critical review of literature using PubMed to confirm or rebut these hypotheses, identify knowledge gaps, and analyse the findings in terms of what in wound care has changed due to the pandemic and what wound care providers need to do differently as a result of these changes. Evidence was graded using the Oxford Centre for Evidence‐Based Medicine scheme. The majority of hypotheses and related suppositions were confirmed, but there is noticeable heterogeneity, so the experiences reported herein are not universal for wound care providers and centres. Moreover, the effects of the dynamic pandemic vary over time in geographic areas. Wound care will unlikely return to prepandemic practices. Importantly, Levels 2–5 evidence reveals a paradigm shift in wound care towards a hybrid telemedicine and home healthcare model to keep patients at home to minimize the number of in‐person visits at clinics and hospitalizations, with the exception of severe cases such as chronic limb‐threatening ischemia. The use of telemedicine and home care will likely continue and improve in the postpandemic era.
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Affiliation(s)
- Vickie R Driver
- Wound Healing, Limb Preservation and Hyperbaric Centers, Inova Heart and Vascular Institute Inova Health System, Falls Church, Virginia, USA
| | - Kara S Couch
- Wound Care Services, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Gary Gibbons
- Center for Wound Healing, South Shore Health, Weymouth, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lorena Henderson
- PULSE Amputation Prevention Centers, Affiliates, El Paso Cardiology Associates, P.A., El Paso, Texas, USA
| | - John Lantis
- Mount Sinai West Hospital, Icahn School of Medicine, New York, New York, USA
| | - Eric Lullove
- West Boca Center for Wound Healing, Coconut Creek, Florida, USA
| | - Paul Michael
- Palm Beach Heart & Vascular, JFK Wound Management & Limb Preservation Center, Lake Worth, Florida, USA
| | - Richard F Neville
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA.,Department of Surgery, Inova Health System, Falls Church, Virginia, USA
| | - Lee C Ruotsi
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
| | - Robert J Snyder
- Barry University School of Podiatric Medicine, Miami Shores, Florida, USA
| | - Fadi Saab
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Michigan, USA
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Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors. Intensive Crit Care Nurs 2021; 69:103160. [PMID: 34789437 PMCID: PMC8552588 DOI: 10.1016/j.iccn.2021.103160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation. Methods Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay. Results Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 (IQR 60–83) hours. Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61–2.97), elbow (OR 1.10, 95%CI:0.45–2.68) and wrist (OR 0.97, 95%CI:0.58–1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02–1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses. Conclusion Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.
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Fourie A, Ahtiala M, Black J, Hevia H, Coyer F, Gefen A, LeBlanc K, Smet S, Vollman K, Walsh Y, Beeckman D. Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study). J Tissue Viability 2021; 30:466-477. [PMID: 34583874 PMCID: PMC8463934 DOI: 10.1016/j.jtv.2021.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/24/2023]
Abstract
Background Ventilating critically ill patients with acute respiratory distress syndrome in the prone position is a life-saving strategy, but it is associated with adverse consequences such as skin damage. Aim To identify, review and evaluate international proning and skin care guidelines and make an inventory of commonly used equipment and training resources. Design A gap analysis methodology was applied. Methods 1) Comprehensive search and evaluation of proning and skin care guidelines, 2) extensive search and listing equipment and educational resources, and 3) international consultation with 11 experts (8 countries). Data sources A variety of sources researched through July 2021 were used to identify relevant literature: (1) scientific literature databases and clinical trials registries, (2) intensive care and wound care associations, (3) healthcare organisations, (4) guideline development organisations, and (5) the Google search engine. Eleven international experts reviewed the literature and provided insights in two, 2-h online sessions. Findings The search yielded 24 guidelines. One clinical practice guideline had high methodological quality. Twenty-five devices/equipment and sixteen teaching materials were identified and discussed with the expert panel. The gap analysis identified a lack of concise, accessible, evidence-based guidelines and educational materials of short duration. Conclusion This analysis forms the basis for designing a competency-based education and training intervention for an interdisciplinary team caring for the skin of critically ill patients in the prone position. Impact The results can assist the multidisciplinary team to review their current protocol for prone positioning. This is a first step in developing a training package for clinicians.
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Affiliation(s)
- Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Maarit Ahtiala
- Service Division, Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
| | - Joyce Black
- Niedfeft Professor of Nursing, University of Nebraska Medical Center, College of Nursing, Omaha NE, USA.
| | - Heidi Hevia
- Nursing School, Nursing Department, Andres Bello University, Viña del Mar, Chile.
| | - Fiona Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia.
| | - Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
| | - Kim LeBlanc
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Wound Ostomy Continence Institute/Association of Nurses Specialized in Wound Ostomy Continence, Ottawa, ON, Canada.
| | - Steven Smet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Kathleen Vollman
- Advancing Nursing LLC, Adjunct faculty Michigan State University, Northville MI, USA.
| | - Yolanda Walsh
- YL Walsh (Pty) Ltd, Adjunct Lecturer Stellenbosch University, Western Cape, South Africa.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
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Rastogi V, Layon AJ. Endotracheal Tube Fastening Device-Related Facial Pressure Ulcers. Cureus 2021; 13:e16796. [PMID: 34513402 PMCID: PMC8405453 DOI: 10.7759/cureus.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) can be present in a substantial number of hospitalized Coronavirus disease 2019 (COVID19) disease patients. Some of these patients progress to severe ARDS and require mechanical ventilation. Patients requiring mechanical ventilation and intensive care unit (ICU) admission are at an increased risk of developing pressure ulcers from multiple medical devices used in their care. In this report, we describe a case of facial pressure ulcers in a 59-year-old COVID19 positive female with ARDS requiring endotracheal intubation and mechanical ventilation.
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Affiliation(s)
| | - Abraham J Layon
- Anesthesiology and Critical Care, The University of Central Florida College of Medicine, Orlando, USA
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Bandeira LDLM, Carvalho SMOD, Calaça LRR, Rabelo GMDS, Barbosa WCF, Machado BADS, Silva JS. STRATEGIES FOR THE PREVENTION OF FACIAL PRESSURE INJURIES CAUSED BY THE USE OF THE PRONE POSITION. ESTIMA 2021. [DOI: 10.30886/estima.v19.1092_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Identify the main strategies for preventing facial pressure injuries caused by the use of the prone position. Methods: Integrative literature review, carried out during the month of March 2021. Articles were searched in the MEDLINE, LILACS, BDENF and IBECS databases. The selected articles were written in English, Portuguese and Spanish, between 2016 and 2021. Duplicates and those that did not include the topic addressed were excluded. Initially, 29 articles were identified. After applying the inclusion and exclusion criteria, 10 articles resulted for analysis. Results: Of the complications related to the use of the prone position, 10 (100%) of the studies address the pressure injury as the main complication of this therapeutic maneuver. As for prevention strategies, the studies analyzed cite the change in position associated with the use of pads and hydrocolloids as the main preventive methods. Conclusion: The following strategies to prevent facial pressure injury by using the prone position were identified: change of decubitus at pre-established times; use of devices that provide relief from pressure points, such as pads and hydrocolloids; and the use of low-cost and easily accessible materials, such as adapted surgical sponges, respecting the anatomical structures of each patient.
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Bandeira LDLM, Carvalho SMOD, Calaça LRR, Rabelo GMDS, Barbosa WCF, Machado BADS, Silva JS. ESTRATÉGIAS DE PREVENÇÃO DE LESÕES POR PRESSÃO FACIAL OCASIONADAS PELO USO DA POSIÇÃO PRONA. ESTIMA 2021. [DOI: 10.30886/estima.v19.1092_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objetivo:Identificar as principais estratégias para prevenção de lesões por pressão faciais ocasionadas pelo uso de posição prona. Métodos:Revisão integrativa de literatura, realizada durante o mês de março de 2021. Foram pesquisados artigos nas bases de dados da MEDLINE, LILACS, BDENF e IBECS. Os artigos selecionados foram redigidos nos idiomas inglês, português e espanhol, entre 2016 e 2021. Foram excluídos os duplicados e os que não incluíam a temática abordada. Inicialmente, foram identificados 29 artigos. Após a aplicação dos critérios de inclusão e exclusão, resultaram 10 artigos para análise. Resultados: Das complicações relacionadas ao uso de posição prona, 10 (100%) dos estudos abordam a lesão por pressão como a principal complicação dessa manobra terapêutica. Quanto às estratégias de prevenção, os estudos analisados citam a mudança de decúbito associada ao uso de coxim e hidrocolóides como principais métodos preventivos. Conclusão: Foram identificadas as seguintes estratégias de prevenção de lesão por pressão facial pelo uso de posição prona: mudança de decúbito em tempos pré-estabelecidos; uso de dispositivos que proporcionam alívio de pontos de pressão, tais como os coxins e hidrocolóides; e a utilização de materiais de baixo custo e fácil acesso, como esponjas cirúrgicas adaptadas, respeitando as estruturas anatômicas de cada paciente.
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Walsh A, Peesay T, Newark A, Shearer S, Parsa K, Pierce M, Gao WZ. Association of Severe Tongue Edema With Prone Positioning in Patients Intubated for COVID-19. Laryngoscope 2021; 132:287-289. [PMID: 34287907 PMCID: PMC8441932 DOI: 10.1002/lary.29773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022]
Abstract
Objectives/Hypothesis Prone positioning is frequently used in patients intubated for COVID‐19‐related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication. Study Design Retrospective cohort study. Methods A single‐system retrospective cohort study of patients intubated for respiratory failure secondary to COVID‐19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020. Results 260 patients were intubated for COVID‐19‐related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. Twelve patients in total (4.6%) developed clinically significant tongue edema. Eleven of the twelve patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96–59.46, P = .027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range, 0–4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management. Conclusions Tongue edema appears to develop in a subset of patients with COVID‐19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. Level of Evidence 4 Laryngoscope, 132:287–289, 2022
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Affiliation(s)
- Amanda Walsh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Tejasvi Peesay
- School of Medicine, Georgetown University, Washington, District of Columbia, U.S.A
| | - Annemarie Newark
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Sarah Shearer
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Keon Parsa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Matthew Pierce
- Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, U.S.A
| | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, U.S.A
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Binda F, Galazzi A, Marelli F, Gambazza S, Villa L, Vinci E, Adamini I, Laquintana D. Complications of prone positioning in patients with COVID-19: A cross-sectional study. Intensive Crit Care Nurs 2021; 67:103088. [PMID: 34244027 PMCID: PMC8166520 DOI: 10.1016/j.iccn.2021.103088] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. METHODS Cross-sectional study conducted in the hub COVID-19 centre in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if no unplanned extubation was recorded. The majority of patients (17.5%) experienced bleeding of upper airways. Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04-3.6). CONCLUSION The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.
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Affiliation(s)
- Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Health Sciences Department, University of Florence, Florence, Italy.
| | - Federica Marelli
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Lucia Villa
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Elisa Vinci
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Ileana Adamini
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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Hocková B, Riad A, Valky J, Šulajová Z, Stebel A, Slávik R, Bečková Z, Pokorná A, Klugarová J, Klugar M. Oral Complications of ICU Patients with COVID-19: Case-Series and Review of Two Hundred Ten Cases. J Clin Med 2021; 10:jcm10040581. [PMID: 33557130 PMCID: PMC7913822 DOI: 10.3390/jcm10040581] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The critically ill patients suffering from coronavirus disease (COVID-19) and admitted to the intensive care units (ICUs) are susceptible to a wide array of complications that can be life-threatening or impose them to long-term complications. The COVID-19 oral mucocutaneous complications require multidisciplinary management and research for their pathophysiological course and epidemiological significance; therefore, the objective of this study was to evaluate the prevalence and characteristics of the critically ill COVID-19 patients with oral complications. METHODS We described the clinical and microbiological characteristics of the critically ill COVID-19 patients in our ICU department (Banska Bystrica, Slovakia). In addition, we reviewed the current body of evidence in Ovid MEDLINE®, Embase, Cochrane Library, and Google Scholar for the oral mucocutaneous complications of ICU patients with COVID-19. RESULTS Three out of nine critically ill patients (33.3%) in our ICU department presented with oral complications including haemorrhagic ulcers and necrotic ulcers affecting the lips and tongue. The microbiological assessment revealed the presence of opportunistic pathogens, confirming the possibility of co-infection. On reviewing the current literature, two hundred ten critically ill patients were reported to have oral complications due to their stay in the ICU setting. Perioral pressure ulcers were the most common complication, followed by oral candidiasis, herpetic and haemorrhagic ulcers, and acute onset macroglossia. The prolonged prone positioning and mechanical ventilation devices were the primary risk factors for those oral complications, in addition to the immunosuppressive drugs. CONCLUSIONS The multidisciplinary approach is strongly advocated for monitoring and management of COVID-19 patients, thus implying that dermatology and oral healthcare specialists and nurses should be integrated within the ICU teams.
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Affiliation(s)
- Barbora Hocková
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia; (B.H.); (A.S.); (R.S.)
- Department of Prosthetic Dentistry, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic
| | - Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (A.P.); (J.K.); (M.K.)
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-721-046-024
| | - Jozef Valky
- Department of Anaesthesiology, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia; (J.V.); (Z.Š.)
| | - Zuzana Šulajová
- Department of Anaesthesiology, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia; (J.V.); (Z.Š.)
| | - Adam Stebel
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia; (B.H.); (A.S.); (R.S.)
| | - Rastislav Slávik
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia; (B.H.); (A.S.); (R.S.)
| | - Zuzana Bečková
- Department of Clinical Microbiology, F. D. Roosevelt University Hospital, 975 17 Banska Bystrica, Slovakia;
- St. Elizabeth University of Health and Social Work, 812 50 Bratislava, Slovakia
| | - Andrea Pokorná
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (A.P.); (J.K.); (M.K.)
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (A.P.); (J.K.); (M.K.)
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (A.P.); (J.K.); (M.K.)
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión [00249], de deterioro de la integridad cutánea [00047] y tisular [00248]. Por su parte, la intervención de enfermería prevención de úlceras por presión [3540], es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas [0204] e integridad tisular: piel y membranas mucosas [1101]. Conclusión: La PP es una terapia coadyuvante recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población.
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