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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024:S0965-206X(24)00082-2. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [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: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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Tang W, Li AP, Zhang WQ, Hu SQ, Shen WQ, Chen HL. Vasoconstrictor Agent Administration as a Risk Factor for Pressure Injury Development in Intensive Care Unit Patients: A Systematic Review and Meta-Analysis. Adv Wound Care (New Rochelle) 2023; 12:560-573. [PMID: 36448592 DOI: 10.1089/wound.2022.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Significance: Pressure injury (PI) is a common critical presentation in intensive care units (ICU) and is an important clinical concern in critical care settings. Some developing data support the vasoconstrictor agent administration as a potential risk factor; however, synthesis of available evidence has not been completed. Recent Advances: Comprehensive tactics were employed to search electronic databases PubMed, Web of Science, and Ovid Embase for data on vasoconstrictor agent administration associated with PI in ICU patients. Extraction was limited to studies that matched the inclusion criteria. The pooled odds ratio and 95% confidence intervals (95% CI) were calculated for dichotomous outcomes. Critical Issues: Twenty-six studies were included, involving 50,192 patients who matched the selection criteria. Around 5.8% of patients (2,523/43,210) got PI in total. PI occurred in 10.9% (1,496/13,675) of the vasoconstrictor agent administration population and 3.5% (1,027/29,503) of the drug-free population. The pooled unadjusted odds ratio was 2.83 (95% CI = 2.21-3.64, p < 0.001). The adjusted odds ratio was 1.83 (95% CI = 1.26-2.68, p = 0.002). Subgroup analysis and meta-regression found that the risk of PI did not vary with research design, time of occurrence, patient age, or male proportion. Future Directions: Vasoconstrictor agent administration raised the risk of PI in critical care patients by nearly twofold. More emphasis should be placed on the timely prevention of PI in patients receiving vasoconstrictor agent administration in the ICU.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Ai-Ping Li
- Taixing People's Hospital, Taizhou, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Sasabe Y, Niitani M, Teramoto C, Yamaga S, Shime N, Tanabe K, Kataoka T, Sawatari H. Deep sedation predicts pressure injury in patients admitted to intensive care units. Nurs Crit Care 2022; 27:877-884. [PMID: 35048476 DOI: 10.1111/nicc.12753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients in intensive care units (ICU) are frequently prescribed sedatives, which might increase the risk for pressure injury (PI). Although the association between sedation and incidence of PI has been noted, the adequate sedation level to prevent the incidence of PI in patients admitted to ICU is still unclear. AIM This study aimed to investigate the association between fluctuating sedation levels and the incidence of PI in patients admitted to ICU. STUDY DESIGN We retrospectively reviewed the medical records of 104 patients admitted to ICU. Data regarding the length of ICU stay (LOS) and comorbid infection were abstracted from medical records. The Richmond Agitation-Sedation Scale (RASS) was scored twice per day, and the standardized RASS (S-RASS, summation of RASS values divided by the number of samples) was used to evaluate changes in sedation levels. RESULTS Among the 104 included patients, 65 patients (62.5%) were male (median age: 68.0 years), and 13 patients (12.5%) had PI during ICU admission. S-RASS scores were lower in patients with PI than in those without PI (P = .0001) even after adjustment for confounders (OR [95%CI]: 0.14 [0.03-0.58], P = .006). The LOS and infections were higher in patients with PI than in those without PI (P < .0001 and P = .005, respectively). The cut-off value of S-RASS for PI incidence was -3.2 (sensitivity: 88%; specificity: 85%), and a significant predictor of PI incidence (HR [95%CI]: 20.07 [2.53-159.11], P = .005). CONCLUSIONS Deeper sedation levels based on S-RASS scores, which account for the effects of fluctuating sedation levels, were a strong, highly accurate predictor of PI incidence in patients admitted to ICU. RELEVANCE TO CLINICAL PRACTICE Assessing fluctuations in the level of sedation using the S-RASS might help to identify sedative-induced PI in patients admitted to ICU.
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Affiliation(s)
- Yayoi Sasabe
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Mayumi Niitani
- Department of Nursing, Graduate School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | - Chie Teramoto
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Yamaga
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen 2022; 30:498-508. [PMID: 35589532 DOI: 10.1111/wrr.13021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
The present study was designed to determine the association between Acute Physiology and Chronic Health Evaluation (APACHE) scale and elevated pressure injure (PI) risk in intensive care units (ICU) and also evaluate the predictive value of APACHE score in PI patients. Comprehensive strategies were used to search studies from PubMed, Web of Science, and Ovid Embase electronic databases for observational studies that provided data about APACHE scores related to PI in ICU. Eligible studies were selected based on inclusion and exclusion criteria. The pooled SMD with 95% confidence intervals were calculated. A summary ROC curve was plotted to calculate area under curve (AUC) for APACHE-II (15-20). Twenty-one studies involving 11,102 patients who met selection criteria were included. The 11.0% of patients (1229/11102) in ICU developed PIs. Overall, the PI group had a higher score compared with the non-PI group in the APACHE II (22.1 ± 8.0 vs. 14.5 ± 7.4, mean ± SD). The APACHE-III of PI patients was significantly more than that in the non-PI group (79.9 ± 25.6 vs. 59.9 ± 30.4, mean ± SD). The pooled SMD was 0.82 (95% CI: 0.58-1.06, I2 = 91.7%, p-value < 0.001). The subgroup analysis revealed that the risk of PIs did not vary with the type of APACHE score (II, III, IV) and the type of study design (case-control, cross-sectional, cohort, longitudinal study). Proportion of males (I2 = 91.68%, p value = 0.090), publish year (I2 = 91.96%, p value = 0.187) and mean age of patients (I2 = 91.96%, p value = 0.937) were not the sources of heterogeneity. APACHE-II (15-20) achieves the best predictive performance in PI, and the prediction accuracy was balanced with equal sensitivity and specificity (Sen: 0.72, 0.62-0.80; Spec: 1.72, 1.25-2.38). In conclusion, higher APACHE scores are frequently accompanied by a higher incidence of PI among critical-care patients. APACHE-II scores (15-20) satisfactorily predicted PI, and strategies to prevent PI should be aggressively implemented.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Man-Li Zha
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Ateeq I, kennedy L, Baby T, Amer I, Chehab F, Salim NA. Associated Risk Factors and Barriers of Pressure Injury Wound Healing Process: A Retrospective Study of Single-Center Experience. DUBAI MEDICAL JOURNAL 2022. [DOI: 10.1159/000525202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Pressure injuries, particularly those involving dressings, are associated with high rates of morbidity, mortality, and costs. Furthermore, it has a significant impact on patients, family members, and health care systems, increasing pain symptoms, wound odor, hospital stay duration, and even mortality, all of which have a negative impact on quality of life. In the medical literature, a number of variables have been identified that predispose patients to poor wound healing. Diabetes mellitus, venous insufficiency, peripheral artery disease, tobacco smoking, low serum albumin, and inflammatory disorders are among the causes. <b><i>Objectives:</i></b> The main aim of this study was to identify risk factors and barriers that may confer on poor wound healing. <b><i>Methods:</i></b> This is a retrospective study, which was carried out in Dubai Hospital, Dubai Health Authority (DHA), for the period June 2020 until December 2020. <b><i>Result:</i></b> The present study consisted of 146 patients. Paired <i>t</i> test revealed statistically significant improvement in pressure injury healing in terms of length and width at discharge compared to pressure injury (<i>p</i>< 0.05). On the other hand, depth improvement was not statistically significant (<i>p</i>> 0.05). χ<sup>2</sup> test revealed a statistically significant relationship between pressure injury healing and low albumin levels, diabetes, and advanced age (<i>p</i> < 0.05), while there was no statistically significant association between the location of the pressure injury and the healing process (<i>p</i>> 0.05). Furthermore, there was no statistically significant relationship between Braden category, length of stay, or patient hospitalization and pressure injury healing (<i>p</i>> 0.05). <b><i>Conclusion:</i></b> The healing process might be influenced by single or multiple factors. The findings of this retrospective study revealed that low albumin levels, diabetes patients, and age all had an impact on the healing of pressure injuries. When planning and implementing a complete pressure injury treatment strategy, health care practitioners should keep these things under consideration. On the other hand, pressure injury’s location, Braden category, length of stay, and patient hospitalization did not reveal a significant effect on wound healing, despite the fact that other studies showed an effect of these factors on the healing process.
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Abstract
OBJECTIVE Pressure ulcers (PUs) are one of the most commonly occurring complications in hospitalised patients. Knowing the size of the problem and its risk factors will help in preventing it. The aim of this study is to measure the incidence of PUs in acute care settings in Jordan and to explore associated risk factors. METHOD A prospective incidence study for hospitalised patients in Jordan according to the European Pressure Ulcer Advisory Panel methodology. All patients admitted into four Jordanian hospitals over a period of six months were included. RESULTS The cumulative incidence rate was 0.48%. Using multivariate analysis, a low albumin level, elevated white blood cells, incontinence and having more chronic illnesses were significantly associated with acquiring PUs. CONCLUSION Incidence of PUs in Jordan is lower when compared with other parts of the world; this could be related to the relatively younger Jordanian population compared with other populations. DECLARATION OF INTEREST The author has no conflicts of interest to declare.
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Affiliation(s)
- Ma'en Aljezawi
- Al al-Bayt University Faculty of Nursing, P.O. Box 130040, Mafraq, 25113, Jordan
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Chou RH, Wu PS, Wang SC, Wu CH, Lu SF, Lien RY, Tsai YL, Lu YW, Kuo MR, Guo JY, Chou RY, Huang PH, Lin SJ. Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients. J Intensive Care 2021; 9:65. [PMID: 34674768 PMCID: PMC8529374 DOI: 10.1186/s40560-021-00581-5] [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: 07/20/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00581-5.
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Affiliation(s)
- Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Shan Wu
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shen-Chih Wang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shu-Fen Lu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ru-Yu Lien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ren Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiun-Yu Guo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ruey-Yi Chou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Critical Care Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shing-Jong Lin
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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Techanivate A, Athibai N, Siripongsaporn S, Singhatanadgige W. Risk Factors for Facial Pressure Ulcers in Patients Who Underwent Prolonged Prone Orthopedic Spine Surgery. Spine (Phila Pa 1976) 2021; 46:744-750. [PMID: 33337680 DOI: 10.1097/brs.0000000000003892] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI This study evaluated incidence and risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position. A total of 300 cases were studied. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. Hypotension, higher temperature, prolonged operation time, and much crystalloid therapy were the independent risk factors.
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Affiliation(s)
- Anchalee Techanivate
- Department of Anesthesiology, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nutwara Athibai
- Department of Anesthesiology, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suvimol Siripongsaporn
- Department of Anesthesiology, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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BAYKAN H. Evaluation of pressure ulcer development and follow-up in Covid-19 patients followed in pandemic intensive care units. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.883135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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10
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Yap TL, Alderden J, Lewis M, Taylor K, Fife CE. Angiosomal Vascular Occlusions, Deep-Tissue Pressure Injuries, and Competing Theories: A Case Report. Adv Skin Wound Care 2021; 34:157-164. [PMID: 33587477 DOI: 10.1097/01.asw.0000732804.13066.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Compression of the soft tissue between a support surface and a bony prominence has long been the accepted primary mechanism of pressure injury (PrI) formation, with the belief that said compression leads to capillary occlusion, ischemia, and tissue necrosis. This explanation presupposes an "outside-in" pathophysiologic process of tissue damage originating at the local capillary level. Despite advances in prevention protocols, there remains a stubbornly consistent incidence of severe PrIs including deep-tissue injuries, the latter usually evolving into stage 4 PrIs with exposed bone or tendon. This article presents just such a perioperative case with the aim of providing further evidence that these more severe PrIs may result from ischemic insults of a named vessel within specific vascular territories (labeled as angiosomes). Pressure is indeed a factor in the formation of severe PrIs, but these authors postulate that the occlusion occurred at the level of a named artery proximal to the lesion. This vascular event was likely attributable to low mean arterial pressure. The authors suggest that the terminology proposed three decades ago to call both deep-tissue injuries and stage 4 PrIs "vascular occlusion pressure injuries" should be the topic of further research and expert consensus.
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Affiliation(s)
- Tracey L Yap
- Tracey L. Yap, PhD, RN, WCC, CNE, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. Jenny Alderden, PhD, APRN, CCRN, CCNS, is Assistant Professor, University of Utah College of Nursing, Salt Lake City, Utah. MaryAnne Lewis, BSN, RN, CWOCN, is Pediatric Wound Nurse, Texas Children's Hospital, The Woodlands, Texas. Kristen Taylor, MSN, RN, CCRN-K, is Director of Critical Care, CHI St Luke's Hospital, The Woodlands. Caroline E. Fife, MD, is Professor of Geriatrics, Baylor College of Medicine, Houston, Texas, and Medical Director, CHI St Luke's Hospital Wound Clinic, The Woodlands
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Bazaliński D, Midura B, Wójcik A, Więch P. Selected Biochemical Blood Parameters and a Risk of Pressure Ulcers in Patients Receiving Treatment in Intensive Care Units. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:177. [PMID: 33669609 PMCID: PMC7922769 DOI: 10.3390/medicina57020177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022]
Abstract
Background and Objectives: This study aimed to assess the level of selected biochemical parameters in venous blood and their potential effects on the development of pressure ulcers in patients treated in intensive care settings. Materials and Methods: Fifty patients hospitalised in an intensive care unit (ICU) were enrolled for the study. The methods used included controlled observation, literature review and medical record analysis. The observation protocol applied in the study consisted of two parts comprising the basic information, sociodemographic data, results of laboratory tests (CRP, PCT, albumin, protein and haemoglobin concentrations) as well as the Braden Scale for Predicting Pressure Ulcer Risk. Results: The subjects presented moderate to high risk of pressure ulcers, reflected by the mean score of 8.18 ± 1.3 points, with minimum and maximum scores of 6 and 12 points, respectively. Normal albumin level was identified in only five subjects (10.0%) while 45 subjects (90.0%) were found with results below the norm. A statistical relationship was observed between such variables as albumin concentration (p < 0.01) and total protein level (p = 0.007). The findings show a strong correlation between the score in the Braden Scale and the level of albumins (R = 0.55). Conclusions: In our study, lower concentrations of albumins and total proteins correspond to a greater risk of pressure ulcers.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (A.W.)
- Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, 35-959 Rzeszów, Poland;
| | - Beata Midura
- Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, 35-959 Rzeszów, Poland;
| | - Anna Wójcik
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland; (D.B.); (A.W.)
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
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Grap MJ, Schubert CM, Munro CL, Wetzel PA, Burk RS, Lucas V, Pepperl A. OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients. AORN J 2020; 109:229-239. [PMID: 30694547 DOI: 10.1002/aorn.12583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data. The multivariable model containing OR bed time, body mass index, and Braden Scale score produced the best prediction of pressure injury (area under the curve = 0.859). A higher body mass index (P = .09), shorter OR bed time (P = .01), and lower Braden Scale score (P = .05) were associated with a greater chance of pressure injury. These results suggest that use of high frequency ultrasound may identify tissue changes before observable skin changes, leading to earlier pressure injury prevention strategies.
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Fife CE, Gkotsoulias E. On the Origin of Intraoperative Pressure Injury: An Angiosomal Theory of Pressure Injury Formation. Adv Wound Care (New Rochelle) 2019; 8:580-584. [PMID: 31832271 DOI: 10.1089/wound.2018.0905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/10/2019] [Indexed: 10/26/2022] Open
Abstract
We review a case of a 22-year-old healthy man who underwent a 5-h maxillofacial surgery while continuously supine with foam pads placed prophylactically over elevated heels. Immediately after surgery, Stage 1 pressure injuries appeared on the left lateral heel and right lateral ankle, despite the absence of local pressure to these areas. Both lesions eventually resolved. Eight months later, a Doppler evaluation was performed of the patient's lower extremities, the peroneal artery and its tributaries were marked, and the intraoperative positioning was simulated to determine if a wedge at the back of the calf could have obstructed blood flow in these vessels. In this position, the feet naturally abducted so that the lateral calcaneal and posterior malleolar arteries became positioned immediately underneath the wedge. We propose a vascular mechanism of pressure injury development, postulating that some heel pressure injuries are not the result of localized pressure but rather angiosomal ischemia, based on the observation that the anatomical pattern of these lesions frequently follow the distribution of a named vessel. We hypothesize that in this case, intraoperative positioning along with permissive hypotension may have occluded arterial or venous flow to the relevant angiosomes, causing an ischemia reperfusion injury to the downstream tissues.
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Affiliation(s)
- Caroline E. Fife
- Baylor College of Medicine, Houston, Texas
- CHI St. Luke's The Woodlands Wound Clinic, The Woodlands, Texas
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14
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Hyun S, Moffatt-Bruce S, Cooper C, Hixon B, Kaewprag P. Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study. JMIR Med Inform 2019; 7:e13785. [PMID: 31322127 PMCID: PMC6670273 DOI: 10.2196/13785] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/15/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background A pressure ulcer is injury to the skin or underlying tissue, caused by pressure, friction, and moisture. Hospital-acquired pressure ulcers (HAPUs) may not only result in additional length of hospital stay and associated care costs but also lead to undesirable patient outcomes. Intensive care unit (ICU) patients show higher risk for HAPU development than general patients. We hypothesize that the care team’s decisions relative to HAPU risk assessment and prevention may be better supported by a data-driven, ICU-specific prediction model. Objective The aim of this study was to determine whether multiple logistic regression with ICU-specific predictor variables was suitable for ICU HAPU prediction and to compare the performance of the model with the Braden scale on this specific population. Methods We conducted a retrospective cohort study by using the data retrieved from the enterprise data warehouse of an academic medical center. Bivariate analyses were performed to compare the HAPU and non-HAPU groups. Multiple logistic regression was used to develop a prediction model with significant predictor variables from the bivariate analyses. Sensitivity, specificity, positive predictive values, negative predictive values, area under the receiver operating characteristic curve (AUC), and Youden index were used to compare with the Braden scale. Results The total number of patient encounters studied was 12,654. The number of patients who developed an HAPU during their ICU stay was 735 (5.81% of the incidence rate). Age, gender, weight, diabetes, vasopressor, isolation, endotracheal tube, ventilator episode, Braden score, and ventilator days were significantly associated with HAPU. The overall accuracy of the model was 91.7%, and the AUC was .737. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index were .650, .693, .211, 956, and .342, respectively. Male patients were 1.5 times more, patients with diabetes were 1.5 times more, and patients under isolation were 3.1 times more likely to have an HAPU than female patients, patients without diabetes, and patients not under isolation, respectively. Conclusions Using an extremely large, electronic health record–derived dataset enabled us to compare characteristics of patients who develop an HAPU during their ICU stay with those who did not, and it also enabled us to develop a prediction model from the empirical data. The model showed acceptable performance compared with the Braden scale. The model may assist with clinicians’ decision on risk assessment, in addition to the Braden scale, as it is not difficult to interpret and apply to clinical practice. This approach may support avoidable reductions in HAPU incidence in intensive care.
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Affiliation(s)
- Sookyung Hyun
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Cheryl Cooper
- Central Quality and Education, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Brenda Hixon
- Health System Nursing Education, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Pacharmon Kaewprag
- Department of Computer Engineering, Ramkhamhaeng University, Bangkok, Thailand
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15
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Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU. Adv Skin Wound Care 2019; 32:359-364. [DOI: 10.1097/01.asw.0000553599.20444.f4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Varaei S, Shirbeygi L, Farahani L, Eslami Hasan Abadi Z, Shamsizadeh M. Comparison the Effects of Massage with Olive Oil and Sweet Almonds Oil on Prevention of Pressure Ulcer in Hospitalized Patients in ICU. ACTA ACUST UNITED AC 2019. [DOI: 10.30699/ajnmc.27.5.353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse 2018; 37:e1-e11. [PMID: 28765361 DOI: 10.4037/ccn2017548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models' predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value.
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Affiliation(s)
- Xiaohong Deng
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ting Yu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ailing Hu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. .,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University. .,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University.
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18
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Cox J, Schallom M. Pressure Injuries in Critical Care: A Survey of Critical Care Nurses. Crit Care Nurse 2018; 37:46-55. [PMID: 28966195 DOI: 10.4037/ccn2017928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critical care nurses must be able to skillfully balance the prevention of adverse events such as pressure injuries in an environment with multiple competing and lifesaving technologies that often take precedent. Despite strategies to prevent them, pressure injuries do occur in intensive care unit patients, and consensus is building that some pressure injuries are unavoidable. OBJECTIVES To determine critical care nurses' attitudes toward prevention of pressure injury and the perceptions of frontline critical care nurses of specific risk factors associated with unavoidable pressure injuries. METHODS A descriptive cross-sectional survey design was used. An online survey was posted on the newsletter website of the American Association of Critical-Care Nurses in January 2016. RESULTS An invitation to participate in the study was emailed to more than 3000 members of the association; 333 nurses responded, for a response rate of approximately 11%. Among the responders, 73% were employed as bedside critical care nurses. More than half (67%) thought that pressure injuries are avoidable, and 66% disagreed that pressure injury prevention was of less interest than other aspects of critical care. The top 2 risk factors for unavoidable pressure injuries were impaired tissue perfusion and impaired tissue oxygenation. CONCLUSION Critical care nurses are steadfast stewards of safe patient care and think that pressure injury prevention is a crucial aspect of the care they deliver every day. The findings on risk factors for unavoidable pressure injuries mirrored those of experts and provide a layer of support for these factors.
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Affiliation(s)
- Jill Cox
- Jill Cox is clinical associate professor, School of Nursing, Rutgers University, Newark, New Jersey, and a wound/ostomy/continence advanced practice nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Marilyn Schallom is a clinical nurse specialist and research scientist, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri.
| | - Marilyn Schallom
- Jill Cox is clinical associate professor, School of Nursing, Rutgers University, Newark, New Jersey, and a wound/ostomy/continence advanced practice nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Marilyn Schallom is a clinical nurse specialist and research scientist, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
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Coyer F, Cook JL, Doubrovsky A, Campbell J, Vann A, McNamara G. Understanding contextual barriers and enablers to pressure injury prevention practice in an Australian intensive care unit: An exploratory study. Aust Crit Care 2018; 32:122-130. [PMID: 29627314 DOI: 10.1016/j.aucc.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Skin integrity management is often a low clinical priority in the intensive care environment, possibly resulting in high pressure injury (PI) prevalence. This article reports the results of the first phase of a multiphased project, "Translating evidence-based pressure injury prevention strategies to the intensive care environment (SUSTAIN study)". The SUSTAIN study used a research translation framework to guide the assessment of research uptake, development, and monitoring of translational strategies to reduce PIs. OBJECTIVE The objective was to assess the enablers and barriers to research translation of evidence-based skin integrity management in one Australian tertiary referral intensive care unit (ICU). METHODS This exploratory study was conducted in an Australian metropolitan tertiary ICU on a sample of 204 registered nurses. Data were collected using (i) a descriptive cross-sectional cohort survey of barriers, enablers, and attitudes to PI prevention, (ii) a cross-sectional survey of PI knowledge, and (iii) focus groups to understand the local contextual factors impacting registered nurses' PI prevention practice. RESULTS Participants reported a moderate to high ability to rise above barriers in PI prevention, a positive attitude towards PI prevention, and considered this a priority in their care of patients. High patient acuity emerged as a barrier to implementing timely PI prevention strategies. In the knowledge, test participants with postgraduate qualifications answered more statements correctly. Focus group data revealed four themes: (i) team ICU, (ii) processes of care, (iii) education for consistency, and (iv) the patient. CONCLUSIONS It is essential that evidence-based PI prevention strategies are provided in the intensive care environment. Our findings indicate that despite positive attitudes and sound knowledge levels, high patient acuity is a significant barrier to evidence implementation.
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Affiliation(s)
- Fiona Coyer
- Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.
| | - Jane-Louise Cook
- School of Nursing, Queensland University of Technology, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Jill Campbell
- School of Nursing, Queensland University of Technology, Australia; Skin Integrity Services, Royal Brisbane and Women's Hospital, Australia.
| | - Amanda Vann
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Greg McNamara
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
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20
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Abstract
OBJECTIVE The aim of this study was to determine whether skin barrier factors were associated with the common complication of pressure ulcers (PrUs) in intensive care unit (ICU) patients. It is unclear whether skin barrier factors influence the development of PrUs. PATIENT POPULATION The sample was composed of 102 ICU patients (54 men, 48 women). The patients ranged in age from 23 to 88 years, with a mean age of 55.7 (SD, 19.1) years. METHODS Demographic variables and the score for the Acute Physiology and Chronic Health Evaluation IV were recorded on admission. The Braden Scale assessment and measurements of the skin barrier factors were performed daily. Standard care for the prevention of PrUs was strictly administered, and PrUs that developed were evaluated according to the recommendations of the US National Pressure Ulcer Advisory Panel 2007 (Note: The authors used the 2007 recommendations at the time of their study.). Data were analyzed using descriptive statistics and logistic regression. RESULTS The mean score for the Braden Scale was 11.2, and the incidence of PrUs was 31.4%. Lower moisture content of the stratum corneum and higher skin surface pH at the lower sacrum and hip were risk factors for PrUs, whereas scapular and heel skin barrier factors were not. CONCLUSION Nursing strategies aimed at preventing PrUs should place added emphasis on the lower sacral and hip regions.
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21
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Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison. Aust Crit Care 2017; 30:244-250. [DOI: 10.1016/j.aucc.2016.12.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
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Frost FS, Fan Y, Harrison A, Modlin T, Samuel S, Thompson N, Katzan I. Failed Removal of Indwelling Urinary Catheters in Patients With Acute Stroke: Incidence and Risk Factors. PM R 2017; 10:160-167. [PMID: 28694220 DOI: 10.1016/j.pmrj.2017.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 03/03/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients who need IUCs have them, and patients who do not need them will have them removed safely, with the goal of reducing medical complications and facilitating the rehabilitation phase of care. OBJECTIVE To determine the incidence of failed removal of IUCs and the factors associated with failed removal in persons hospitalized with acute stroke. DESIGN Retrospective review of medical records and associated clinical data collection platforms. SETTING Comprehensive stroke center at a tertiary care hospital. PATIENTS The study cohort included 175 stroke patients admitted to the hospital and managed with IUCs. Mean age was 66.1 years (standard deviation = 15), 55% were female. METHODS Univariable and multiple logistic regression analyses were performed. Variables assessed included age, gender, race, duration of hospital stay, stroke subtype, National Institutes of Health Stroke Scale, and 6-Clicks Scale, which is a measure of functional status. MAIN OUTCOME MEASUREMENTS The dependent variable was occurrence of a failed attempt at removal of an IUC, defined as removal followed by a catheter reinsertion. RESULTS During the study period, 175 of 432 patients with acute hospital admission for new stroke had an IUC removal event. Of these patients, 46 (26%) experienced a failed catheter removal. On univariate analysis, factors significantly associated with failed removal included presence of a hemorrhagic stroke (P = .005), lower level of physical function (by 6-Clicks and NIHSS scores), hospital length of stay (P < .001), and discharge location (P = .005). Bedside bladder ultrasound testing by nursing staff was used more frequently in the group of patients who had unsuccessful IUC removals (95% confidence interval 4.56-21.67, P < .001). Length of stay (P < .001), white race (P = .001), and hemorrhagic stroke (P = .009) were associated independently with failed catheter removal after adjustment for other clinical variables. CONCLUSIONS This single-site study identified a high incidence of failed urinary catheter removal in patients with stroke, along with factors associated with failed removal. This is the first step in developing a predictive model that could reduce the incidence of this adverse event. Policies, penalties, and protocols designed to reduce catheter days must be sensitive to the special situations in which IUCs are medically necessary and equal consideration given to identifying the patients for which catheter removal poses a greater risk than continued catheter use. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frederick S Frost
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Youran Fan
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Alexander Harrison
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Trey Modlin
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Susan Samuel
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Nicholas Thompson
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
| | - Irene Katzan
- Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, 9500 Euclid Ave Desk S31, Cleveland, OH 44195.,Cleveland Clinic Foundation, Neurological Institute Center for Outcomes Research, Cleveland, OH.,Cleveland Clinic Foundation, Physical Medicine and Rehabilitation, Cleveland, OH.,Cleveland Clinic Foundation, Neurology, Cleveland, OH
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Forriez O, Masseline J, Coadic D, David V, Trouiller P, Sztrymf B. Efficacy and safety of a new coverlet device on skin microclimate management: a pilot study in critical care patients. J Wound Care 2017; 26:51-57. [PMID: 28182521 DOI: 10.12968/jowc.2017.26.2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the effect of a new coverlet device, allowing air circulation at the body/underlying surface interface, on skin microclimate management. METHOD This prospective observational pilot study took place in a 15-bed university-affiliated intensive care unit. Overall, 34 mechanically ventilated patients were included. Skin humidity and temperature were monitored before and after the implementation of the tested device at the occiput, scapulas, buttocks and sacrum. Humidity and temperature were evaluated through surface skin impedance and an infra-red thermometer, respectively. Health professionals were asked to evaluate the device. RESULTS After implementation of the coverlet device, there was a rapid, sustained and significant decrease in skin humidity at all sites ranging from 6 % to 15 %, excluding the occiput. Skin temperature also significantly decreased from 1 % at both scapulas, but not at the other studied body sites. No side effects were observed. Health professionals reported that the device was easy and quick to install. Although they did not report a subjective improvement in skin moisture or temperature, they considered the device to be efficient. CONCLUSION Although limited by its design, this pilot study suggests a good efficacy of the studied device on skin microclimate management. Further data are warranted to test the clinical implications of our findings.
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Affiliation(s)
| | - J Masseline
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - D Coadic
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - V David
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - P Trouiller
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - B Sztrymf
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France; INSERM U999, Université Paris Sud, Le plessis Robinson, France
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Mizuno J, Takahashi T. Evaluation of external pressure to the sacral region in the lithotomy position using the noninvasive pressure distribution measurement system. Ther Clin Risk Manag 2017; 13:207-213. [PMID: 28255240 PMCID: PMC5322810 DOI: 10.2147/tcrm.s122489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pressure ulcers (PUs) in the sacral region can be a complication of surgical procedures performed in the lithotomy position. Previous reports have noted a difference between men and women in PU development related to the supine position, and body weight and body mass index (BMI) have been also described as known risk factors in supine position-related PU development. The BIG-MAT® system is a noninvasive pressure distribution measurement device used to measure external pressure (EP). We used this system to investigate the relationship between EP to the sacral region in the lithotomy position and selected physical characteristics. METHODS We recruited 21 young, healthy volunteers (11 men and 10 women, aged 21.4±0.5 years). Using the BIG-MAT system, we measured four types of EP to the sacral region: box pressure, peak box pressure, contact pressure, and peak contact pressure. We analyzed the relationships between these dynamic parameters and physical characteristics of the participants. RESULTS There were no differences between men and women in the four types of EP, and no significant differences related to the participants' height, weight, or BMI. CONCLUSION An individual's height, weight, and BMI may not contribute to the risk of inducing lithotomy position-related PUs in the sacral region. The noninvasive pressure distribution measurement system BIG-MAT for patients in the lithotomy position during surgery could become a significant device when estimating EP at the sacral region.
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Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja-shi, Okayama, Japan
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25
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Otero DP, Domínguez DV, Fernández LH, Magariño AS, González VJ, Klepzing JG, Montesinos JB. Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial. J Wound Care 2017; 26:128-136. [DOI: 10.12968/jowc.2017.26.3.128] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D. Peña Otero
- Professor, University General Hospital Gregorio Marañón; Gregorio Marañón Healthcare Research Institute–Nursing Department (IiSGM); Centre for Health Sciences San Rafael–Antonio Nebrija University, Madrid, Spain
| | | | | | - A. Santano Magariño
- Director Nursing Department, University General Hospital Puerta de Hierro, Madrid, Spain
| | | | | | - J.V. Beneit Montesinos
- Director, Professor, Clinic Complutense University; Complutense University, Madrid, Spain
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26
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Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients. Intensive Crit Care Nurs 2016; 38:1-9. [PMID: 27836262 DOI: 10.1016/j.iccn.2016.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/29/2016] [Accepted: 07/27/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations. DESIGN, SETTING, PATIENTS Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24hours of intubation. MEASUREMENTS Tissue interface pressure was measured continuously using the XSENSOR pressure mapping system (XSENSOR Technology Corporation, Calgary, Canada). Skin integrity was observed at all sites, twice daily, using the National Pressure Ulcer Advisory Panel staging system, for the first seven ICU days and at day 10 and 14. RESULTS Of the 132 subjects, 90.9% had no observed changes in skin integrity. Maximum interface pressure was above 32mmHg virtually 100% of the time for the sacrum, left and right trochanter. At the 45mmHg level, the left and right trochanter had the greatest amount of time above this level (greater than 95% of the time), followed by the sacrum, left and right scapula, and the left and right heels. Similarly, at levels above 60mmHg, the same site order applied. For those six subjects with sacral skin integrity changes, maximum pressures were greater than 32mmHg 100% of the time. Four of the six sacral changes were associated with greater amounts of time above both 45mmHg and 60mmHg than the entire sample. CONCLUSIONS Maximum tissue interface pressure was above critical levels for the majority of the documented periods, especially in the sacrum, although few changes in skin integrity were documented. Time spent above critical levels for mean pressures were considerably less compared to maximum pressures. Maximum pressures may have reflected pressure spikes, but the large amount of time above the critical pressure levels remains substantial.
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27
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Kalowes P, Messina V, Li M. Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit. Am J Crit Care 2016; 25:e108-e119. [PMID: 27802960 DOI: 10.4037/ajcc2016875] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. OBJECTIVES To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care. Secondary goals were to examine risk factors for HAPUs in critically ill patients and to explicate cost savings related to prevention of pressure ulcers. METHODS A prospective, randomized controlled trial in the intensive care units at a 569-bed, level II trauma hospital. All 366 participants received standard pressure ulcer prevention; 184 were randomized to have a 5-layered soft silicone foam dressing applied to the sacrum (intervention group) and 182 to receive usual care (control group). RESULTS The incidence rate of HAPUs was significantly less in patients treated with the foam dressing than in the control group (0.7% vs 5.9%, P = .01). Time to injury survival analysis (Cox proportional hazard models) revealed the intervention group had 88% reduced risk of HAPU development (hazard ratio, 0.12 [95% CI, 0.02-0.98], P = .048). CONCLUSION Use of a soft silicone foam dressing combined with preventive care yielded a statistically and clinically significant benefit in reducing the incidence rate and severity of HAPUs in intensive care patients. This novel, cost-effective method can reduce HAPU incidence in critically ill patients.
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Affiliation(s)
- Peggy Kalowes
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
| | - Valerie Messina
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
| | - Melanie Li
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
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Bly D, Schallom M, Sona C, Klinkenberg D. A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit. Am J Crit Care 2016; 25:156-64. [PMID: 26932918 DOI: 10.4037/ajcc2016840] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although most intensive care patients are at risk for pressure ulcers, not all experience such ulcers. OBJECTIVE To examine a model of variables related to extrinsic and intrinsic pressure on skin and underlying tissues, oxygenation, perfusion, and baseline comorbid conditions to identify risk factors associated with pressure ulcers in critically ill adults. METHOD A retrospective chart review was conducted on patients identified by weekly rounds from January 2010 through October 2010 to determine the prevalence of pressure ulcers. Variables were analyzed via bivariate analysis and logistic regression for unit-acquired pressure ulcers. RESULTS Data on 345 patients with 436 intensive care admissions were reviewed. Variables were significant in each model category at P < .05. In the regression analysis of first admission only (n = 306), the model was significant (P < .001) and yielded correct classification of 86.3% of patients. For all intensive care admissions (n = 391), the model was significant (P < .001) and yielded correct classification of 83.9% of patients. In both models, 4 of the same variables were significant: any transport off the unit, number of days to bed change, systolic blood pressure less than 90 mm Hg, and use of more than 1 vasopressor. History of pulmonary disease and presence of a feeding tube were also significant in regression analyses. CONCLUSIONS Several variables within the model of pressure, oxygenation, and perfusion were significantly associated with development of pressure ulcers.
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Affiliation(s)
- Deborah Bly
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Marilyn Schallom
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Carrie Sona
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Dean Klinkenberg
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
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Soppi E, Iivanainen A, Sikanen L, Jouppila-Kupiainen E. Performance of different support surfaces during experimental resuscitation (CPR). Heliyon 2016; 2:e00074. [PMID: 27441253 PMCID: PMC4945897 DOI: 10.1016/j.heliyon.2016.e00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 12/02/2022] Open
Abstract
The relationship between the efficacy of resuscitation and the mattresses and backboards used in acute care units, has been studied previously. However, few reports focus on the relative efficacy of resuscitation when using mattresses with different modes of function. This study examines the performance of different support surfaces during experimental cardiopulmonary resuscitation (CPR). The surfaces included a hard surface, a higher specification foam mattress, a dynamic, alternating pressure mattress, and a dynamic, reactive minimum pressure air mattress system. A pressure sensitive mat was placed between the mattresses and each surface and the efficacy of resuscitation measured using differences in compression frequency, compression depth and hands-on time. Our results suggest that the efficacy of resuscitation is dependent on the mode of action of the mattress, while adequate compression frequency and depth do not have a significant effect. In the open system alternating mattress, deflation of the mattress using the CPR function improved the stability of the resuscitation in our study, especially in situations where the height of the air mattress is greater than 20–25 centimeters. Using our experimental system, resuscitation on a closed air system mattress optimally combined stability and effort, while the CPR function converts the air system of the mattress to open, which impairs its functionality during resuscitation. These results indicate that resuscitation is dependent of the mode of action of the mattress and whether the mattress-specific CPR function was used or not. However, the interactions are complex and are dependent on the interaction between the body and the mattress, i.e. its immersion and envelopment properties. Furthermore, this study casts doubt on the necessity of the CPR function in air mattresses.
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Affiliation(s)
| | | | - Leila Sikanen
- Mikkeli University of Applied Sciences, Mikkeli, Finland
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31
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Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:744-758. [PMID: 26838530 DOI: 10.1177/0148607115625638] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.
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Affiliation(s)
- Charles Chin Han Lew
- 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.,2 Dietetic and Nutrition Department, Jurong Health Services, Singapore
| | - Rosalie Yandell
- 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Robert J L Fraser
- 3 Department of Gastroenterology and Hepatology, Flinders University, Adelaide, South Australia, Australia
| | - Ai Ping Chua
- 4 Department of Respiratory Medicine, Jurong Health Services, Singapore
| | - Mary Foong Fong Chong
- 5 Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore
| | - Michelle Miller
- 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
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Cox J, Roche S. Vasopressors and development of pressure ulcers in adult critical care patients. Am J Crit Care 2015; 24:501-10. [PMID: 26523008 DOI: 10.4037/ajcc2015123] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. OBJECTIVE To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. METHODS A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. RESULTS Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. CONCLUSION The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.
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Affiliation(s)
- Jill Cox
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
| | - Sharon Roche
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
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Fulbrook P, Anderson A. Pressure injury risk assessment in intensive care: comparison of inter-rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales. J Adv Nurs 2015; 72:680-92. [DOI: 10.1111/jan.12825] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Paul Fulbrook
- Australian Catholic University; Brisbane Queensland Australia
- The Prince Charles Hospital; Brisbane Queensland Australia
| | - Alissa Anderson
- Intensive Care Unit; The Prince Charles Hospital; Brisbane Queensland Australia
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Enteral nutrition in dementia: a systematic review. Nutrients 2015; 7:2456-68. [PMID: 25854831 PMCID: PMC4425154 DOI: 10.3390/nu7042456] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 12/12/2022] Open
Abstract
The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life.
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Period Prevalence of Pressure Ulcer in Jordanian Intensive Care Units. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwak HR, Kang J. Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission. ACTA ACUST UNITED AC 2015. [DOI: 10.7475/kjan.2015.27.3.347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hye Ran Kwak
- Dong-A University Medical Center, CCU, Busan, Korea
| | - Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
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Gardiner JC, Reed PL, Bonner JD, Haggerty DK, Hale DG. Incidence of hospital-acquired pressure ulcers - a population-based cohort study. Int Wound J 2014; 13:809-20. [PMID: 25469585 DOI: 10.1111/iwj.12386] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 11/30/2022] Open
Abstract
Our study sought to estimate the association between race, gender, comorbidity and body mass index (BMI) on the incidence of hospital-acquired pressure ulcer (PU) from a population-based retrospective cohort comprising 242 745 unique patient hospital discharges in two fiscal years from July 2009 to June 2010 from 15 general and tertiary care hospitals. Cases were patients with a single inpatient encounter that led to an incident PU. Controls were patients without a PU at any encounter during the two fiscal years with the earliest admission retained for analysis. Logistic regression models quantified the association of potential risk factors for PU incidence. Spline functions captured the non-linear effects of age and comorbidity. Overall 2·68% of patients experienced an incident PU during their inpatient stay. Unadjusted analyses revealed statistically significant associations by age, gender, race, comorbidity, BMI, admitted for a surgical procedure, source of admission and fiscal year, but differences by gender and race did not persist in adjusted analyses. Interactions between age, comorbidity and BMI contributed significantly to the likelihood of PU incidence. Patients who were older, with multiple comorbidities and admitted for a surgical diagnosis-related groups (DRG) were at greater risk of experiencing a PU during their stay.
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Affiliation(s)
- Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
| | - Philip L Reed
- Clinical and Translational Sciences Institute, Michigan State University, East Lansing, MI, USA.,Biomedical Research Informatics Core, Michigan State University, East Lansing, MI, USA
| | - Joseph D Bonner
- Information Technology Services/Data Governance and Research, CHE/Trinity Health, Livonia, MI, USA
| | - Diana K Haggerty
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Daniel G Hale
- Information Technology Services/Data Governance and Research, CHE/Trinity Health, Livonia, MI, USA
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Kim H, Chang SJ. Clinical Usefulness of Gastric Residual Volume as An Indicator to Provide Approximately Enteral Nutrition for Patients in Intensive Care Units: A Systematic Literature Review. ACTA ACUST UNITED AC 2014. [DOI: 10.7586/jkbns.2014.16.4.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ahtiala MH, Soppi ET, Wiksten A, Koskela H, Grönlund JA. Occurrence of Pressure Ulcers and Risk Factors in a Mixed Medical-Surgical ICU — A Cohort Study. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2010, a three-year research programme was launched to study the occurrence and significance of certain risk factors for pressure ulcers (PUs) in a mixed intensive care unit (ICU), and to find previously unidentified risk factors. A modified Jackson/Cubbin (mJ/C) risk scale was used to formalise PU risk assessment. Adult patients needing intensive or high dependency care were included. The first results of a whole cohort (n=1,629 patients) treated in 2010 are reported. In this cohort, 72% of the patients had a surgical condition and 31% needed treatment for three or more days. The prevalence of PUs was 11.8% and the incidence was 11.1% (181/1,629) or the incidence rate was 3.0/100 ICU days. The most common sites of PUs were the sacrum, heels and nose. Nasal PUs were associated with masks used for noninvasive ventilation. Demographic variables did not differ between patients with or without PUs. Medical patients had the highest incidence of PUs (18.2%). In this group, 46.6% of patients without PU had a mJ/C-score ≤29 and 55.8% of the patients with PUs had a similar score. Patients with longer treatment times (three days or more) and medical patients had increased risk for PU development. The results indicate that the previously published J/C cut-off score of 29 may not be optimal for the identification of high/extremely high-risk patients. Further analysis of the patient populations, their PU risk factors and the significance of individual components of the J/C risk scale are ongoing.
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Affiliation(s)
- Maarit H Ahtiala
- Registered Nurse, Authorized Wound Care Nurse, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital, Finland
- Consultant in Anesthesiology, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital
| | - Esa T Soppi
- Consultant in Internal Medicine, Eira Hospital, Helsinki
- Consultant in Anesthesiology, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital
| | - Anna Wiksten
- Statistician, Statfinn Ltd. Espoo
- Consultant in Anesthesiology, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital
| | - Hanne Koskela
- Statistician, Statfinn Ltd. Espoo
- Consultant in Anesthesiology, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital
| | - Juha A Grönlund
- Consultant in Anesthesiology, Perioperative Services, Intensive Care Medicine and Pain Management Service Division, Turku University Hospital
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Relación entre el índice de masa corporal y el desarrollo de úlcera por presión en Medicina Intensiva. ENFERMERIA INTENSIVA 2014; 25:107-13. [DOI: 10.1016/j.enfi.2014.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/23/2014] [Accepted: 03/09/2014] [Indexed: 11/24/2022]
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Hyun S, Vermillion B, Newton C, Fall M, Li X, Kaewprag P, Moffatt-Bruce S, Lenz ER. Predictive validity of the Braden scale for patients in intensive care units. Am J Crit Care 2013; 22:514-20. [PMID: 24186823 DOI: 10.4037/ajcc2013991] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients in intensive care units are at higher risk for development of pressure ulcers than other patients. In order to prevent pressure ulcers from developing in intensive care patients, risk for development of pressure ulcers must be assessed accurately. OBJECTIVES To evaluate the predictive validity of the Braden scale for assessing risk for development of pressure ulcers in intensive care patients by using 4 years of data from electronic health records. Methods Data from the electronic health records of patients admitted to intensive care units between January 1, 2007, and December 31, 2010, were extracted from the data warehouse of an academic medical center. Predictive validity was measured by using sensitivity, specificity, positive predictive value, and negative predictive value. The receiver operating characteristic curve was generated, and the area under the curve was reported. RESULTS A total of 7790 intensive care patients were included in the analysis. A cutoff score of 16 on the Braden scale had a sensitivity of 0.954, specificity of 0.207, positive predictive value of 0.114, and negative predictive value of 0.977. The area under the curve was 0.672 (95% CI, 0.663-0.683). The optimal cutoff for intensive care patients, determined from the receiver operating characteristic curve, was 13. CONCLUSIONS The Braden scale shows insufficient predictive validity and poor accuracy in discriminating intensive care patients at risk of pressure ulcers developing. The Braden scale may not sufficiently reflect characteristics of intensive care patients. Further research is needed to determine which possibly predictive factors are specific to intensive care units in order to increase the usefulness of the Braden scale for predicting pressure ulcers in intensive care patients.
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Affiliation(s)
- Sookyung Hyun
- Sookyung Hyun is an assistant professor in the College of Nursing and the Department of Biomedical Informatics at The Ohio State University, Columbus, Ohio. Brenda Vermillion is director of nursing education in the Department of Health Services Nursing Education, Wexner Medical Center and clinical assistant professor at the College of Nursing at The Ohio State University. Cheryl Newton is a clinical nurse specialist in the Department of Critical Care Nursing, Wexner Medical Center at The Ohio State University. Monica Fall is a dietitian in the Department of Nutrition Services, Wexner Medical Center at The Ohio State University. Xiaobai Li is a bio-statistician in the Center for Biostatistics, Wexner Medical Center at The Ohio State University. Pacharmon Kaewprag is a doctoral candidate in the Department of Computer Science and Engineering, The Ohio State University. Susan Moffatt-Bruce is an associate professor in the Department of Surgery, Wexner Medical Center at The Ohio State University. Elizabeth R. Lenz is a professor emeritus in the College of Nursing at The Ohio State University
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Filius A, Damen T, Schuijer-Maaskant K, Polinder S, Hovius S, Walbeehm E. Cost analysis of surgically treated pressure sores stage III and IV. J Plast Reconstr Aesthet Surg 2013; 66:1580-6. [DOI: 10.1016/j.bjps.2013.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/27/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
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Nassaji M, Askari Z, Ghorbani R. Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. Int J Nurs Pract 2013; 20:418-23. [PMID: 25157943 DOI: 10.1111/ijn.12141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess relationship between smoking, some other risk factors and ulcers development in intensive care unit. This prospective cohort study was performed in two university-affiliated hospitals. The sample consisted of adult male patients who were admitted to medical-surgical intensive care units. All eligible patients were grouped according to their cigarette smoking status as smoker and non-smoker. The final sample included 160 smokers and 192 non-smokers. Pressure ulcer occurred in 62 smoker patients and 28 of non-smoker who showed significant difference. Also number of pack-year of cigarettes smoking showed significant association with ulcer development. Ulcer stage was significantly different between the two groups. Besides of smoking, age, length of stay, faecal incontinency, diabetes mellitus, anaemia and trauma were significantly associated with pressure ulcers. Our study showed significant association between smoking and development of pressure ulcers.
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Affiliation(s)
- Mohammad Nassaji
- Department of Infectious Diseases, Fatemieh Hospital, Semnan University of Medical Science, Semnan, Iran
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45
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Abstract
Pressure ulcers (a type of skin failure) have served as an indicator of care quality. The purpose of this study was to utilize data-mining techniques as a means of identifying risk factors related to different stages of pressure ulcers to demonstrate how this means of analysis might be used as a vehicle to guide improved care quality. Data were obtained from a Web-based incident reporting system at a regional hospital in Taiwan. A total of 4301 cases dating from March 2005 to May 2009 were collected. For data-cleaning purposes, data within 3 SDs were kept for further analysis. Data-mining techniques were applied to identify the predictors, and a logistic regression analysis was used for result comparison purposes. The results revealed that sacral ulcer was the most prevalent, and most ulcers were in stage I, followed by stages II to IV. Five predictors were identified including hemoglobin, weight, sex, height, and use of repositioning sheet. The study concluded that nurses could use data-mining technique to identify predictors to assist in guiding ulcer interventions such as those based on a patient's demographic profile and application of a repositioning sheet to prevent ulcer occurrence to minimize harm.
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Why patients in critical care do not receive adequate enteral nutrition? A review of the literature. J Crit Care 2012; 27:702-13. [DOI: 10.1016/j.jcrc.2012.07.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 02/06/2023]
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47
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Serra R, Caroleo S, Buffone G, Lugarà M, Molinari V, Tropea F, Amantea B, de Franciscis S. Low serum albumin level as an independent risk factor for the onset of pressure ulcers in intensive care unit patients. Int Wound J 2012; 11:550-3. [PMID: 23170878 DOI: 10.1111/iwj.12004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/25/2012] [Indexed: 12/01/2022] Open
Abstract
Critically ill patients are at high risk of developing pressure ulcers (PUs) and patients who develop PUs remain significantly longer in the intensive care unit (ICU) with significantly increased morbidity and mortality. Therefore, the identification of patients at truly increased risk is important. The aim of this study was to examine the association of low serum albumin present at admission in ICU patients with the onset of PUs. We conducted a retrospective cohort study on 610 patients who were admitted to intensive care unit. Level of serum albumin and other biochemical indices, recorded at the time of admission, were collected. We collected information about PU occurrence after admission and conducted a statistical analysis with biomarkers at ICU admission and during hospital stay. The incidence of PU in the ICUs was 31% and about 70% of patients with PUs had hypoalbuminemia at admission. The lowest values of serum albumin in patients with PUs were directly proportional to the severity of ulcers. In this study, we found a close association between serum albumin and PUs. In fact serum albumin was negatively correlated with PU and may be considered one of the independent determinants of PU occurrence in patients admitted to ICUs.
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Affiliation(s)
- Raffaele Serra
- Chair of Surgery, Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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[Pressure ulcers in the critical patient: detection of risk factors]. ENFERMERIA INTENSIVA 2012; 23:155-63. [PMID: 22947456 DOI: 10.1016/j.enfi.2012.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 05/17/2012] [Accepted: 06/06/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patients admitted to intensive care units (ICU) are more vulnerable to the appearance of pressure ulcers. This is the reason why the highest rates of pressure ulcers (PU) incidence and prevalence are found in the ICU. This study has aimed to identify risk factors related to the appearance of PU in critically ill patients. PATIENTS AND METHOD This was a prospective and observational study that included all patients admitted for more than 24 h from October 2009 to June 2010. Dependent variable: Appearance of PU. INDEPENDENT VARIABLES APACHE II score, risk assessment score (EMINA), body mass index (BMI), support surface, nutrition, norepineprhine, sedation and care support devices. Data analyses: Kaplan-Meyer survival and Cox regression analysis. Significance p < 0.05. RESULTS A total of 236 patients were included. A significant association was found to BMI≥30 (RR: 2.51), EMINA >10 (RR: 2.96), hyperproteic nutrition (RR: 0.946), turning (RR: 0.88), sedation (RR: 0.95), polyurethane nasogastric feeding tube (RR: 0.94), dynamic support surface (RR:0.88). Significant association of p < 0.1 for Norepinephrine (RR: 2.34). CONCLUSIONS BMI≥ 30, EMINA and norepinephrine are predictive factors of risk for PU development. Sedation days, dynamic support surfaces, hyperproteic nutrition, turning, and polyurethane nasogastric feeding tube were established as protective factors against PU.
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Air-Fluidized Therapy in Patients With Suspected Deep Tissue Injury. J Wound Ostomy Continence Nurs 2012; 39:555-61. [DOI: 10.1097/won.0b013e318264c2ec] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumagai R, Kubokura M, Sano A, Shinomiya M, Ohta S, Ishibiki Y, Narumi K, Aiba M, Ichimiya Y. Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia. Psychiatry Clin Neurosci 2012; 66:418-22. [PMID: 22834660 DOI: 10.1111/j.1440-1819.2012.02378.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to clinically evaluate percutaneous endoscopic gastrostomy (PEG) tube feeding of elderly Japanese patients with dementia. METHOD The records of the 155 patients with dementia who underwent PEG in Juntendo Tokyo Koto Geriatric Medical Center were reviewed for pertinent clinical data, including diagnosis of dementia, place of stay before and after hospitalization, as well as survival rate, albumin levels, and incidence of aspiration pneumonia (AP) before and 6 months after PEG feeding. The latter three data of these patients were compared with those of 106 patients with dementia fed through a nasogastric (NG) tube. RESULTS Alzheimer's disease and vascular dementia were predominant. Fifty-three percent of the patients were admitted from their home; the number of discharges to homes decreased to 21.2%. The mean (SD) of the albumin levels was 2.9 (0.4) g/dl before feeding and 2.9 (0.6) g/dl after 6 months. Among the patients with AP before PEG tube feeding, 51.6% had an AP recurrence. Conversely, AP occurred in 9.4% of the patients without AP before feeding. The patient survival rate was higher by 27 months when using PEG tube than when using an NG tube. CONCLUSION PEG tube feeding in patients with dementia leads to preservation of status for a few years. Compared with NG tube feeding, PEG tube feeding did not induce AP due to impairment of intact swallowing function, and was associated with higher survival rate of approximately 2 years. However, PEG tube feeding does not seem to promote home medical care.
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Affiliation(s)
- Ryo Kumagai
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
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