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Pressure Injury Risk Assessment in Pediatric Intensive Care: A Prospective Validation Study of the Glamorgan Scale and Predictive Comparison with the Braden Q Scale. Adv Skin Wound Care 2023; 36:1-7. [PMID: 36806282 DOI: 10.1097/01.asw.0000918880.95690.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To validate the Glamorgan Scale and compare its predictive ability in assessing pressure injury risk among patients in a pediatric ICU (PICU) with that of the Braden Q Scale. METHODS A prospective cohort study was performed to validate the Glamorgan Scale and compare its predictive ability with the Braden Q Scale in a PICU population. A total of 83 patients admitted in the PICU between February and July 2020 met the inclusion criteria and were included in the study, leading to 639 measurements. The authors tested the psychometric properties of the Glamorgan Scale to validate whether the characteristics of the original version were preserved. To this end, reliability (internal consistency) and concurrent and predictive validity (sensitivity and specificity) were assessed. For the predictive comparison, the authors performed the same tests with the Braden Q Scale. RESULTS The predictive validity, as assessed by the receiver operator characteristic curve and calculation of the area under the curve, showed satisfactory performance for the Glamorgan Scale (0.77; CI, 0.72-0.82); the Braden Q Scale values were similar (0.78; CI 0.73-0.84). The Spearman correlation coefficient showed a strong correlation between the total scores of the Glamorgan Scale (ρ = -0.76; P < .01), corroborating its validation. CONCLUSIONS The Glamorgan Scale was validated and showed good accuracy and consistency for pressure injury risk assessment in critically ill pediatric patients in Brazil. Its accuracy was similar to that of the Braden Q Scale.
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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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Abstract
OBJECTIVE An interprofessional team known as the Tracheostomy Steering Committee (TSC) was established to prevent tracheotomy-related pressure injuries (TRPIs) and standardize practice for tracheostomy insertion and care of patients with tracheostomies. In addition to reducing the number TRPIs, the TSC sought establish an escalation process for all clinicians to raise concerns about the care and management of patients with tracheostomies. METHODS This quality improvement initiative used the Define, Measure, Analyze, Improve, and Control framework with a pre- and postintervention design. The TSC created a TRPI-prevention bundle that included recommendations for protective foam dressing and skin barrier film use, suture tension, timing of suture removal, stoma care, offloading and positioning, escalation, documentation, and dual skin assessment. An electronic tracheostomy report was developed to track patients with a tracheostomy across the enterprise. RESULTS A total of 289 patients had a tracheostomy during their inpatient hospital stay from January 2018 through December 2019. There was an observed a reduction in the daily rate of TRPIs by 50% with the use of the standardized TRPI-prevention bundle. CONCLUSIONS Use of the bundle resulted in a significant reduction in the incidence of TRPI. Timely escalation of possible tracheostomy injuries or tracheostomies at risk enabled rapid intervention, likely preventing many injuries, and real-time feedback to clinicians reinforced best practices. Interprofessional collaboration is necessary to provide optimal tracheostomy care and ensure the best outcomes.
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Vocci MC, Lopes Saranholi T, Amante Miot H, Fernandes Abbade LP. Intensive Care Pressure Injuries: A Cohort Study Using the CALCULATE and Braden Scales. Adv Skin Wound Care 2022; 35:1-8. [PMID: 35188486 DOI: 10.1097/01.asw.0000815488.17717.68] [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: 11/26/2022]
Abstract
OBJECTIVE Identify both the risk of developing pressure injuries (PIs) by applying the CALCULATE (CriticAL Care pressure ULcer Assessment Tool made Easy) and Braden Scales and the incidence of PIs in adult patients in intensive care. METHODS This prospective cohort study was conducted from March 2016 to February 2017 in an adult ICU. The Braden and CALCULATE scales were applied every 48 hours until medical discharge, death, or PI development. RESULTS The sample included 100 patients. The investigators obtained 818 evaluations (409 Braden and 409 CALCULATE) with an average of 4.1 observations per patient. According to the CALCULATE scale, 49 participants (49%) were classified as very high risk, compared with 40 participants (40%; P = .204) according to the Braden Scale. Thirty-five patients developed 37 PIs, with a total incidence of 35%. The mean age of patients who developed PIs was 60.3 (SD, 13.7) years, and they averaged 9.2 (SD, 6.8) days of hospitalization, with diagnoses related to cardiorespiratory and neurologic diseases and associated comorbidities of hypertension, diabetes mellitus, and smoking. The most affected site was the sacral region; 64.9% of the injuries were classified as stage 1. CONCLUSIONS Patients in intensive care were high risk according to both PI scales, and many developed PIs. It is evident that even when preventive measures are used, they are insufficient without the implementation of preventive protocols.
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Affiliation(s)
- Marcelli Cristine Vocci
- At the São Paulo State University, Botucatu, São Paulo, Brazil, Marcelli Cristine Vocci, MSN, is a PhD student, Medical School; Taís Lopes Saranholi, MSN, is a PhD student, Medical School; Hélio Amante Miot, PhD, is Professor, Dermatology Department; and Luciana Patricia Fernandes Abbade, PhD, is Professor, Dermatology Department. The authors have disclosed no financial relationships related to this article. Submitted March 1, 2021; accepted in revised form May 6, 2021
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Berry KG, Seiple SM, Stellar JJ, Nagle ML, Curry K, Immel A, James R, Srinivasan V, Mascarenhas MR, Garrett A, Irving SY. A scoping review to inform a multi-disciplinary approach for nutrition therapy in critically ill children with pressure injuries. Transl Pediatr 2021; 10:2799-2813. [PMID: 34765502 PMCID: PMC8578773 DOI: 10.21037/tp-21-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Nutrition status plays a critical role in pressure injury (PI) healing and yet the available literature, especially in pediatric patients, is limited. Critically ill pediatric patients are at an increased risk of skin integrity compromise and PI development. Adequate nutritional intake can often be challenging to achieve in this population and immobility and illness present additional obstacles to maintaining skin integrity in this vulnerable population. Despite the unique nutritional challenges and needs of this group, there is no standardized approach to macro- and micronutrient management and monitoring. Here, several key vitamins and minerals believed to play a role in PI healing are discussed and an approach to nutritional management and monitoring for PI healing in pediatric patients is proposed. Registered dietitians (RD) are essential to assess individual patient macro and micronutrient requirements, to identify gaps and make recommendations to optimize nutritional therapy that may exist and impact wound healing. We used a scoping review to focus on the interplay of nutrition and PI healing and inform a multidisciplinary approach to PI identification and management. Through this review, we propose a strategy for the nutritional management of pediatric patients <30 kg at risk for and who present with PI.
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Affiliation(s)
- Katarina G Berry
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie M Seiple
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judith J Stellar
- Department of Nursing and General Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica L Nagle
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kelsey Curry
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda Immel
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard James
- University of Pennsylvania Biomedical Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Vijay Srinivasan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Maria R Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Garrett
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Department of Nursing and Clinical Care, Critical Care Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
PURPOSE The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. DESIGN A prospective, descriptive study. SAMPLE/SUBJECTS AND SETTING The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. METHODS Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. RESULTS Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. CONCLUSION Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.
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Hong S, Wang H, Tian Y, Qiao L. The roles of noninvasive mechanical ventilation with helmet in patients with acute respiratory failure: A systematic review and meta-analysis. PLoS One 2021; 16:e0250063. [PMID: 33857228 PMCID: PMC8049716 DOI: 10.1371/journal.pone.0250063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the safety and effectiveness between helmet and face mask noninvasive mechanical ventilation (NIMV) in patients with acute respiratory failure (ARF). Methods English databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. Chinese databases involved Wanfang Data, China Knowledge Resource Integrated Database and Chinese Biological Medicine Database. Randomized controlled trials (RCTs) comparing helmet and face mask NIMV for patients with ARF were searched. Meta-analysis was performed using Review manager 5.1.0. Results Twelve trials with a total of 569 patients were eligible. Our meta-analysis showed that, comparing with face mask, helmet could significantly decrease the incidences of intolerance [risk ratio (RR) 0.19; 95% confidence interval (CI) 0.09−0.39], facial skin ulcer (RR 0.19; 95% CI 0.08−0.43) and aerophagia (RR 0.15; 95% CI 0.06−0.37), reduce respiratory rate [mean difference (MD) -3.10; 95% CI -4.85 to -1.34], intubation rate (RR 0.39; 95% CI 0.26−0.59) and hospital mortality (RR 0.62; 95% CI 0.39−0.99) in patients with ARF, and improve oxygenation index in patients with hypoxemic ARF (MD 55.23; 95% CI 31.37−79.09). However, subgroupanalysis for hypercapnic ARF revealed that PaCO2 was significantly reduced in face mask group compared with helmet group (MD 5.34; 95% CI 3.41−7.27). Conclusion NIMV with helmet can improve the patient’s tolerance, reduce adverse events, increase oxygenation effect, and decrease intubation rate and hospital mortality comparing to face mask. However, the low number of patients from included studies may preclude strong conclusions. Large RCTs are still needed to provide more robust evidence.
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Affiliation(s)
- Shukun Hong
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
- * E-mail:
| | - Hongye Wang
- Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying, China
| | - Yonggang Tian
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
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Galligan MM, Wolfe HA, Papili KE, Porter E, O'Shea K, Liu H, Colfer A, Neiswender K, Granahan K, McGowan N, McGrath AM, Shaw KN, Sutton RM. Implementation of a Multidisciplinary Debriefing Process for Pediatric Ward Deterioration Events. Hosp Pediatr 2021; 11:454-461. [PMID: 33858988 DOI: 10.1542/hpeds.2020-002014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Event debriefing has established benefit, but its adoption is poorly characterized among pediatric ward providers. To improve patient safety, our hospital restructured its debriefing process for ward deterioration events culminating in ICU transfer. The aim of this study was to describe this process' implementation. METHODS In the restructured process, multidisciplinary ward providers are expected to debrief all ICU transfers. We conducted a multimethod analysis using facilitative guides completed by debriefing participants. Monthly debriefing completion served as an adoption metric. RESULTS Between March 2019 and February 2020, providers across 9 wards performed debriefing for 134 of 312 PICU transfers (43%). Bedside nurses participated most frequently (117 debriefings [87%]). There was no significant difference in debriefing by unit, acuity, season, or nurse staffing. Compared with units fully staffed by rotational frontline clinicians (FLCs; eg, resident physicians), units with dedicated FLCs whose responsibilities are primarily limited to that unit (eg, oncology hospitalists) completed significantly more monthly debriefings (average [SD] 57% [30%] vs 33% [28%] of PICU transfers; P = .004). FLC participation was also higher on these units (50% of debriefings [37%] vs 24% [37%]; P = .014). Through qualitative analysis, we identified distinct debriefing themes, with teaming activities such as communication cited most often. CONCLUSIONS Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.
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Affiliation(s)
- Meghan M Galligan
- Departments of Pediatrics, .,Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather A Wolfe
- Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and.,Anesthesiology and Critical Care Medicine
| | | | - Ezra Porter
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kelly O'Shea
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Andrea Colfer
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kristin Neiswender
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | | | - Anne Marie McGrath
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kathy N Shaw
- Departments of Pediatrics.,Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and
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Gasparino RC, Lima MHM, de Souza Oliveira-Kumakura AR, da Silva VA, de Jesus Meszaros M, Antunes IR. Prophylactic dressings in the prevention of pressure ulcer related to the use of personal protective equipment by health professionals facing the COVID-19 pandemic: A randomized clinical trial. Wound Repair Regen 2020; 29:183-188. [PMID: 33215768 PMCID: PMC7753594 DOI: 10.1111/wrr.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
Device-related pressure injury (DRPI) is a serious problem that is affecting professionals working on the front lines against COVID-19 due to the prolonged use of personal protective equipment (PPE). In addition to the physical and psychological integrity of professionals, these injuries can compromise the quality of care. Therefore, using technologies to prevent this adverse effect is an urgent matter. This is a parallel two-arm randomized clinical trial without the use of a control group to compare the use of foam and extra-thin hydrocolloid in preventing DRPI associated with the use of PPE by health professionals working on the front lines against coronavirus. In total, 88 professionals were divided into two groups: foam and hydrocolloid. Data were collected using two instruments and related to demographic and professional characteristics and skin evaluation. Each volunteer received one of the dressings, both with the same dimensions and arranged over similar regions, and data were gathered at baseline and after 6 or 12 hours. Descriptive and inferential analytic statistical methods were used; the significance level adopted was 5%. No participant developed DRPI, but four areas with hyperemia were observed in the foam group (two in the forehead, one in the cheeks, and one in the nose bridge), as well as four areas with hyperemia in the hydrocolloid group (two in the nose bridge, one in the right ear, and one in the left ear). There was no difference between the groups regarding skin conditions and discomfort (P > .05). The average cost obtained was $ 5.8/person and $ 4.4/person in the foam group and the hydrocolloid group, respectively, considering the dressing measurements. The results show that foam and extra-thin hydrocolloid were effective in preventing DRPI associated with the use of PPE.
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Vocci MC, Onary ASS, Castro MCNE, Spadotto AFDO, Fontes CMB. Análise retrospectiva da aplicação da escala de Braden Q em terapia intensiva pediátrica. ESTIMA 2020. [DOI: 10.30886/estima.v18.941_pt] [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
Objetivo: caracterizar o perfil dos pacientes que desenvolveram lesão por pressão e analisar os escores retrospectivos obtidos na aplicação da Escala de Braden Q em terapia intensiva pediátrica. Método: estudo de coorte retrospectivo com análise de dados secundários de 34 prontuários eletrônicos de pacientes internados em terapia intensiva pediátrica. Resultados: da análise dos escores obtidos com aplicação da Escala de Braden Q, foram identificados seis registros de lesão por pressão; a média de idade foi de 8,1 anos; 66,6% do sexo masculino; média de 41 dias de internação; principais diagnósticos estão relacionados a doenças do sistema respiratório, cardíaco e neurológico; todos utilizaram suporte de ventilação mecânica invasiva e apresentaram prescrição de jejum e uso de sonda nasogástrica. Conclusão: o perfil clínico está correlacionado ao sexo masculino, à maior frequência de doenças respiratórias com necessidade de ventilação mecânica, ao uso de drogas vasoativas, vasopressoras e sedativas, e à sonda como via de administração de dieta. Todos apresentaram escores de alto risco para desenvolvimento de lesão por pressão.
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Vocci MC, Onary ASS, Castro MCNE, Spadotto AFDO, Fontes CMB. Retrospective analysis of the application of the Braden Q scale in pediatric intensive care. ESTIMA 2020. [DOI: 10.30886/estima.v18.941_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: to characterize the profile of patients who developed pressure injuries and to analyze the retrospective scores obtained in the application of the Braden Q Scale in pediatric intensive care. Method: retrospective cohort study with analysis of secondary data from 34 electronic medical records of patients admitted to pediatric intensive care. Results: from the analysis of the scores obtained with the application of the Braden Q Scale, six records of pressure injuries were identified; the average age was 8.1 years; 66.6% were male; average of 41 days of hospitalization; main diagnoses are related to diseases of the respiratory, cardiac and neurological systems; all used invasive mechanical ventilation support and had a fasting prescription and use of a nasogastric tube. Conclusion: the clinical profile is correlated with the male gender, the higher frequency of respiratory diseases requiring mechanical ventilation, the use of vasoactive, vasopressor and sedative drugs, and the tube as a route of dietary administration. All of them had high risk scores for developing pressure injuries.
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Investigating the Efficacy of Hydrocolloid Dressing for Preventing Nasotracheal Tube-Related Pressure Injury in the PICU. Pediatr Crit Care Med 2020; 21:e752-e758. [PMID: 32740180 DOI: 10.1097/pcc.0000000000002494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the efficacy of hydrocolloid dressing in reducing the occurrence rate and severity of nasotracheal tube-related pressure injury. DESIGN Randomized controlled trial. SETTING A PICU in a tertiary medical center in southern China. PATIENTS Pediatric patients received invasive mechanical ventilation via nasotracheal tubes. INTERVENTIONS The hydrocolloid dressing was cut into an optimal square size, which should cover the area from the nasal columella to the ala. MEASUREMENTS AND MAIN RESULTS Eligible participants were randomly allocated to the control group and the experimental group. The participants in the experimental group received hydrocolloid dressing to protect nasal skin from the beginning of nasotracheal intubation, while the participants in the control group received the current care procedure (without hydrocolloid dressing) unless pressure injuries occurred. The hydrocolloid dressing was changed daily to assess the nasal skin. The pressure injury staging system that was redefined and updated by the National Pressure Ulcer Advisory Panel in 2016 was used. The mean duration of nasotracheal intubation was 150.10 ± 117.09 hours in the experimental group and 161.75 ± 120.72 hours in the control group. Forty-five participants had nasotracheal tube-related pressure injuries in control group, whereas 26 patients had in experimental group (72.6% vs 43.3%; absolute difference, 29.3%, 95% CI, 12.5-46%; p = 0.001). The median survival times of the nasal skin integrity were 95.5 hours in the control group and 219.5 hours in the experimental group (p < 0.001). CONCLUSIONS Hydrocolloid dressing can not only reduce the occurrence rate of nasotracheal tube-related pressure injury in the child with long-term nasotracheal intubation but also improve the endurance of the nasal skin significantly.
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Reducing Pediatric Tracheostomy Wound Complications: An Evidence-Based Literature Review. Adv Skin Wound Care 2020; 33:324-328. [PMID: 32427789 DOI: 10.1097/01.asw.0000661808.51766.9a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To discuss prevention strategies that can mitigate the frequency of tracheostomy-related wound complications. DATA SOURCES A systematic literature review of PubMed between 2010 and 2019. STUDY SELECTION Full-text articles written in English language and studying human participants younger than 18 years. DATA EXTRACTION The primary outcome was the rate of tracheostomy-related skin complications after implementation of a given intervention. Secondary outcomes included rates of accidental decannulation or other complications. DATA SYNTHESIS A total of 348 studies were identified and 6 met inclusion criteria. There were 1,607 children included with interventions designed to reduce peristomal and cervical wound complications in 1,174 (73.1%). Strategies considered safe and effective included protective skin barriers, reducing prolonged pressure, and early wound identification protocols. CONCLUSIONS Wound complications after pediatric tracheostomy can be reduced using a multifaceted approach by providers committed to making skin care a priority.
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Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Adv Skin Wound Care 2019; 32:394-408. [DOI: 10.1097/01.asw.0000577124.58253.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kim HK, Kim Y, Son HM. Characteristics Influencing the Occurrence of Respiratory Medical Device-related Pressure Ulcers in the Pediatric Intensive Care Unit. CHILD HEALTH NURSING RESEARCH 2019; 25:133-142. [PMID: 35004406 PMCID: PMC8650919 DOI: 10.4094/chnr.2019.25.2.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/27/2018] [Accepted: 12/23/2018] [Indexed: 12/03/2022] Open
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Liao Y, Gao G, Mo L. Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis. Int J Nurs Sci 2018; 5:419-426. [PMID: 31406858 PMCID: PMC6626287 DOI: 10.1016/j.ijnss.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/31/2018] [Accepted: 08/31/2018] [Indexed: 12/16/2022] Open
Abstract
Aims Paediatric pressure ulcers are a serious problem to healthcare service. Thus, effective and early identification of the risk of developing pressure ulcer is essential. The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer, but its predictive power is controversial. Hence, we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision. Methods Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese, including Medline, Cochrane Library, Embase, CINAHL, SinoMed, CNKI, Wangfang and VIP. The studies were screened by two independent reviewers. QUADAS-2 was used to assess the risk of bias of eligible studies. Demographic data and predictive value indices were extracted. The pooled sensitivity, specificity and receiver operating characteristics (ROC) were calculated by MetaDiSc 1.4 using random-effects models. Results Cochran Q = 26.13 (P = 0.0036) indicated the existence of heterogeneity; the I2 for pooled DOR was 61.7%, suggesting significant heterogeneity among the included studies. The pooled sensitivity and specificity were 0.73 (95% CI: 0.67–0.78) and 0.61 (95% CI: 0. 59–0.63), respectively, yielding a combined DOR of 3.47 (95% CI: 2–6.01). The area under the ROC curve was 0.7078 ± 0.0421, and the overall diagnostic accuracy (Q*) was 0.6591 ± 0.0337. Sensitivity analysis showed the results were robust. Conclusion The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children. Further development and modification of this tool for use in paediatric population are warranted.
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Affiliation(s)
- Yaoji Liao
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Guozhen Gao
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lulu Mo
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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