Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients

Construction of the discomfort assessment scale for immobilized trauma victims (DASITV)

BACKGROUND

Immobilization is an intervention widely administered to trauma victims and aims to reduce the victim's movements, ensuring the alignment of anatomical structures suspected of being injured. Despite the benefits of immobilization, it is responsible for the occurrence of pressure injuries, increases in intercranial pressure, pain, and discomfort.

AIM

To develop an instrument to assess the discomfort caused by immobilization in trauma victims - Discomfort Assessment Scale for Immobilized Trauma Victims (DASITV).

METHODS

A sequential mixed-methods design was used, divided into three distinct but complementary phases: (1) Conceptualization Phase - Construction of the DASITV; (2) Focus Group with a Panel of ten Technical Experts in the care of immobilized trauma victims to approve the DASITV proposal; (3) Acceptance of the scale proposal using a modified e-Delphi technique with 30 pre-hospital health professionals.

RESULTS

The first phase led to the construction of a scale made up of two sub-scales. The Numerical Discomfort Scale assesses the level of discomfort the person reports from 0 to 10, with 0 being no discomfort and 10 being maximum discomfort. The second evaluation parameter gives the level of pressure in mmHg that the body exerts on the surface where it is immobilized. The combined interpretation of these two sub-scales leads to 4 different possibilities - ordered by level of severity. The Focus Group made it possible to improve the scale, with input from the group of experts and, using the modified e-Delphi technique, a wider group of professionals showed agreement with the DASITV.

CONCLUSION

This study allowed us to propose a preliminary scale to assess the discomfort felt by victims of trauma caused by immobilization.

The occurrence of pressure injuries and related risk factors in patients undergoing extracorporeal membrane oxygenation for respiratory failure: A retrospective single centre study

INTRODUCTION

Limited data is available regarding the incidence of pressure injuries in patients who have undergone Extracorporeal Membrane Oxygenation (ECMO), a life-saving technique that provides respiratory support for hypoxemia that does not respond to conventional treatment.

AIM

To assess the incidence of pressure injuries and identify the risk factors in Acute Respiratory Distress Syndrome patients receiving ECMO.

METHODS

A retrospective observational study utilizing prospectively collected data was performed in an Italian intensive care unit, between 1 January 2012 and 30 April 2022 enrolling all consecutive patients with Acute Respiratory Distress Syndrome who underwent ECMO.

RESULTS

One hundred patients were included in this study. 67 patients (67%) developed pressure injuries during their intensive care unit stay, with a median of 2 (1-3) sites affected. The subgroup of patients with pressure injuries was more hypoxic before ECMO implementation, received more frequent continuous renal replacement therapy and prone positioning, and showed prolonged ECMO duration, intensive care unit and hospital length of stay compared to patients without pressure injuries. The logistic model demonstrated an independent association between the pO2/FiO2 ratio prior to ECMO initiation, the utilization of the prone positioning during ECMO, and the occurrence of pressure injuries.

CONCLUSIONS

The incidence of pressure injuries was elevated in patients with Adult Respiratory Distress Syndrome who received ECMO. The development of pressure injuries was found to be independently associated with hypoxemia before ECMO initiation and the utilization of prone positioning during ECMO.

IMPLICATIONS FOR CLINICAL PRACTICE

Patients who require ECMO for respiratory failure are at a high risk of developing pressure injuries. To ensure optimal outcomes during ECMO implementation and treatment, it is vital to implement preventive measures and to closely monitor skin health in at-risk areas.

Impact of shear stress on sacral pressure injury from table rotation during laparoscopic colorectal surgery performed in the lithotomy position

This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.

Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study

Background and Aim

Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development.

Methods

A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated.

Results

The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively.

Conclusion

Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados

Background

The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados.

Methods

A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms.

Results

Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions.

Conclusion

The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.

Using Continuous Intraoperative Pressure Mapping to Describe Patterns of Tissue Interface Pressure

The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical locations exceeded 32 mm Hg, and examine associations between patient- and surgery-related variables and peak tissue interface pressure. We used a pressure mapping system to measure the intraoperative tissue interface pressure of 150 patients. We implemented linear mixed-effects models to assess trends in the mean and peak tissue interface pressure. The percentage of time during which the interface pressure exceeded 32 mm Hg at the scapulae, interscapular area, and sacral area was 70%, 70%, and 90%, respectively. Body mass index, length of surgery, and intraoperative position were major predictors of increased pressure. Understanding patterns of tissue interface pressure of patients during surgery may help perioperative nurses develop strategies to attenuate pressure and protect skin integrity.

Battery-free, wireless soft sensors for continuous multi-site measurements of pressure and temperature from patients at risk for pressure injuries

Capabilities for continuous monitoring of pressures and temperatures at critical skin interfaces can help to guide care strategies that minimize the potential for pressure injuries in hospitalized patients or in individuals confined to the bed. This paper introduces a soft, skin-mountable class of sensor system for this purpose. The design includes a pressure-responsive element based on membrane deflection and a battery-free, wireless mode of operation capable of multi-site measurements at strategic locations across the body. Such devices yield continuous, simultaneous readings of pressure and temperature in a sequential readout scheme from a pair of primary antennas mounted under the bedding and connected to a wireless reader and a multiplexer located at the bedside. Experimental evaluation of the sensor and the complete system includes benchtop measurements and numerical simulations of the key features. Clinical trials involving two hemiplegic patients and a tetraplegic patient demonstrate the feasibility, functionality and long-term stability of this technology in operating hospital settings.

Collar pressure mapping: An evaluation of seven collar types used on working donkeys in Europe

BACKGROUND

Working donkeys represent an important source of energy worldwide. Poor working conditions and equipment affect their ability to work. Poorly designed, ill-fitted harness causes inefficient transfer of power and leads to health and welfare issues. Using technology to assess different types of collars provides a better understanding of those that are most efficient for working donkeys.

MATERIALS AND METHODS

Seven different collars were tested using pressure pads. Contact area, median, maximum and peak pressures were obtained for the whole collar and critical points. Eight donkeys pulled 20% and 40% of their body weight, using each collar, under controlled conditions.

RESULTS

Contact area and pressures vary between collars and effort, with design and expansion capacity of the collars playing a major role. Simple collars designed specifically for donkeys performed well, with full collars designed for horses also having good results. Due to reduced expansion capacity and contact in the critical points, the breast collars were the least effective.

CONCLUSION

Design, appropriate padding and manufacturing materials and adjustment capacity are key features for good collars, and such parameters are of paramount importance in terms of health and welfare for working donkeys.

Characteristics of Critically Ill Adults With Sacrococcygeal Unavoidable Hospital-Acquired Pressure Injuries: A Retrospective, Matched, Case-Control Study

PURPOSE

To identify characteristics of critically ill adults with sacrococcygeal, unavoidable hospital-acquired pressure injuries (uHAPIs).

DESIGN

Retrospective, matched, case-control design.

SUBJECTS/SETTING

Patients admitted to adult intensive care units (ICUs) at an urban academic medical center from January 2014 through July 2016.

METHODS

Thirty-four patients without uHAPI were matched to 34 patients with sacrococcygeal uHAPI. Time points of interest included admission to the ICU, the week preceding the definitive assessment date, and hospital discharge status. Variables of interest included length of stay, any diagnosis of sepsis, severity of illness, degree of organ dysfunction/failure, supportive therapies in use (eg, mechanical ventilation), and pressure injury risk (Braden Scale score).

RESULTS

All 34 sacrococcygeal pressure injuries were classified as uHAPI using the pressure injury prevention inventory instrument. No statistically significant differences were noted between patients for severity of illness, degree of organ dysfunction/failure, or pressure injury risk at ICU admission. At 1 day prior to the definitive assessment date and at discharge, patients with uHAPI had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores (greater organ dysfunction/failure) and lower mean Braden Scale scores (greater pressure injury risk) than patients without uHAPI. Patients with uHAPI had significantly longer lengths of stay, more supportive therapies in use, were more often diagnosed with sepsis, and were more likely to die during hospitalization.

CONCLUSION

Sacrococcygeal uHAPI development was associated with progressive multiorgan dysfunction/failure, greater use of supportive therapies, sepsis diagnosis, and mortality. Additional research investigating the role of multiorgan dysfunction/failure and sepsis on uHAPI development is warranted.

Battery-free, wireless sensors for full-body pressure and temperature mapping

Thin, soft, skin-like sensors capable of precise, continuous measurements of physiological health have broad potential relevance to clinical health care. Use of sensors distributed over a wide area for full-body, spatiotemporal mapping of physiological processes would be a considerable advance for this field. We introduce materials, device designs, wireless power delivery and communication strategies, and overall system architectures for skin-like, battery-free sensors of temperature and pressure that can be used across the entire body. Combined experimental and theoretical investigations of the sensor operation and the modes for wireless addressing define the key features of these systems. Studies with human subjects in clinical sleep laboratories and in adjustable hospital beds demonstrate functionality of the sensors, with potential implications for monitoring of circadian cycles and mitigating risks for pressure-induced skin ulcers.

A Human Body Pressure Distribution Imaging System Based on Wavelet Analysis and Resistance Tomography

In this paper, a pressure distribution sensing system based on wavelet analysis and resistance tomography is proposed to overcome the shortcomings of a traditional electrode type pressure distribution sensor, which needs to be arranged with many electrodes and has a high production cost. The system uses ADS1256, a constant current source module, a serial communication module, a Raspberry host, a touch screen, and other components. The wavelet transform is used to preprocess the collected signal to improve the anti-jamming performance of the system. The method of resistance tomography is used to realize the real-time imaging of pressure distribution. Finally, the reliability of the system is verified using conductive silica gel as a sensitive material. The experimental results show that wavelet analysis preprocessing can significantly improve the quality of pressure distribution imaging.