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Gordon RJFH, Worsley PR, Filingeri D. An evaluation of the effects of localised skin cooling on microvascular, inflammatory, structural, and perceptual responses to sustained mechanical loading of the sacrum: A study protocol. PLoS One 2024; 19:e0303342. [PMID: 38728306 PMCID: PMC11086830 DOI: 10.1371/journal.pone.0303342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
This study protocol aims to investigate how localised cooling influences the skin's microvascular, inflammatory, structural, and perceptual tolerance to sustained mechanical loading at the sacrum, evaluating factors such as morphology, physiology, and perceptual responses. The protocol will be tested on individuals of different age, sex, skin tone and clinical status, using a repeated-measure design with three participants cohorts: i) young healthy (n = 35); ii) older healthy (n = 35); iii) spinal cord injured (SCI, n = 35). Participants will complete three testing sessions during which their sacrum will be mechanically loaded (60 mmHg; 45 min) and unloaded (20 min) with a custom-built thermal probe, causing pressure-induced ischemia and post-occlusive reactive hyperaemia. Testing sessions will differ by the probe's temperature, which will be set to either 38°C (no cooling), 24°C (mild cooling), or 16°C (strong cooling). We will measure skin blood flow (via Laser Doppler Flowmetry; 40 Hz); pro- and anti-inflammatory biomarkers in skin sebum (Sebutape); structural skin properties (Optical Coherence Tomography); and ratings of thermal sensation, comfort, and acceptance (Likert Scales); throughout the loading and unloading phases. Changes in post-occlusive reactive hyperaemia will be considered as the primary outcome and data will be analysed for the independent and interactive effects of stimuli's temperature and of participant group on within- and between-subject mean differences (and 95% Confidence Intervals) in peak hyperaemia, by means of a 2-way mixed model ANOVA (or Friedman). Regression models will also be developed to assess the relationship between absolute cooling temperatures and peak hyperaemia. Secondary outcomes will be within- and between-subject mean changes in biomarkers' expression, skin structural and perceptual responses. This analysis will help identifying physiological and perceptual thresholds for the protective effects of cooling from mechanically induced damage underlying the development of pressure ulcers in individuals varying in age and clinical status.
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Affiliation(s)
- Ralph J. F. H. Gordon
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Peter R. Worsley
- PressureLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Davide Filingeri
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
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Han H, Oh YS, Cho S, Park H, Lee SU, Ko K, Park JM, Choi J, Ha JH, Han C, Zhao Z, Liu Z, Xie Z, Lee JS, Min WG, Lee BJ, Koo J, Choi DY, Je M, Sun JY, Park I. Battery-Free, Wireless, Ionic Liquid Sensor Arrays to Monitor Pressure and Temperature of Patients in Bed and Wheelchair. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2205048. [PMID: 36534830 DOI: 10.1002/smll.202205048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/20/2022] [Indexed: 06/17/2023]
Abstract
Repositioning is a common guideline for the prevention of pressure injuries of bedridden or wheelchair patients. However, frequent repositioning could deteriorate the quality of patient's life and induce secondary injuries. This paper introduces a method for continuous multi-site monitoring of pressure and temperature distribution from strategically deployed sensor arrays at skin interfaces via battery-free, wireless ionic liquid pressure sensors. The wirelessly delivered power enables stable operation of the ionic liquid pressure sensor, which shows enhanced sensitivity, negligible hysteresis, high linearity and cyclic stability over relevant pressure range. The experimental investigations of the wireless devices, verified by numerical simulation of the key responses, support capabilities for real-time, continuous, long-term monitoring of the pressure and temperature distribution from multiple sensor arrays. Clinical trials on two hemiplegic patients confined on bed or wheelchair integrated with the system demonstrate the feasibility of sensor arrays for a decrease in pressure and temperature distribution under minimal repositioning.
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Affiliation(s)
- Hyeonseok Han
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Yong Suk Oh
- Department of Mechanical Engineering, Changwon National University, Changwon, 51140, Republic of Korea
| | - Seokjoo Cho
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Hyunwoo Park
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Sung-Uk Lee
- Advanced 3D Printing Technology Development Division, Korea Atomic Energy Research Institute, Daejeon, 34057, Republic of Korea
| | - Kabseok Ko
- Department of Electronics Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea
| | - Jae-Man Park
- Department of Materials Science & Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jungrak Choi
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Ji-Hwan Ha
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Chankyu Han
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Zichen Zhao
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, 116024, P. R. China
| | - Zhuangjian Liu
- Institute of High-Performance Computing, Agency for Science, Technology and Research, Singapore, 138632, Singapore
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, 116024, P. R. China
| | - Je-Sang Lee
- Department of Rehabilitation Medicine, Gimhae Hansol Rehabilitation & Convalescent Hospital, Gimhae, 50924, Republic of Korea
| | - Weon Gi Min
- Department of Planning and Development, Gimhae Hansol Rehabilitation & Convalescent Hospital, Gimhae, 50924, Republic of Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Jahyun Koo
- School of Biomedical Engineering, Korea University, Seoul, 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Republic of Korea
| | - Dong Yun Choi
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology (KITECH), Yeongcheon, 38822, Republic of Korea
| | - Minkyu Je
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Jeong-Yun Sun
- Department of Materials Science & Engineering, Seoul National University, Seoul, 08826, Republic of Korea
- Research Institute of Advanced Materials (RIAM), Seoul National University, Seoul, 08826, Republic of Korea
| | - Inkyu Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
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Itakura DA, Nakato AM, Hembecker PK, Neves EB, Nohama P. Thermal changes in the sacral region with different mattresses used in the prevention of pressure injuries. J Therm Biol 2022; 110:103366. [PMID: 36462883 DOI: 10.1016/j.jtherbio.2022.103366] [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: 06/15/2021] [Revised: 08/01/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pressure Injury (PI) is a severe health problem that affects millions of people. As a preventive strategy for high-risk ICU patients, the appropriate selection of a support surface is essential for preventing PI, along with risk assessment and repositioning. Increasing skin temperature has been associated with a higher susceptibility to PI development. OBJECTIVE This study aimed to evaluate thermal variations related to skin pressure in the sacral area of healthy individuals lying on three different mattresses models (standard, inflatable air, and egg crate). DESIGN Experimental study. MAIN OUTCOMES Initially, a survey was performed to identify the mattresses models most used in four public university hospitals and preventive strategies adopted. And then, an experimental study was conducted with a non-probabilistic sample involving 28 individuals of both sexes, aged 18-35 years old. The volunteers were immobilized for 2 h, and temperature variations in the sacral region were obtained by acquiring thermal images. RESULTS A significant difference was not found in the temperature recorded on the three mattresses models before the experiment. However, there were significant differences at the 1st and 31st minute (p < 0.001). The lowest temperature values were identified in the air inflatable mattress. Post-hoc comparisons revealed a significant difference between standard or egg crate mattresses and the inflatable air model. CONCLUSION The inflatable air mattress should be considered for preventing pressure injury in ICU patients since the temperature had returned to the initial value (pre-test) after the 31st min. In addition to the appropriate selection surface, risk assessment and positioning are essential to PI prevention strategies.
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Affiliation(s)
- Daniela Akemi Itakura
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Adriane Muller Nakato
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Paula Karina Hembecker
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Universidade Tecnológica Federal do Paraná (UTFPR), Brazil.
| | - Percy Nohama
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
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Bambi AA, Yusuf S, Irwan AM. Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review. Adv Skin Wound Care 2022; 35:263-270. [PMID: 35442919 DOI: 10.1097/01.asw.0000824552.38110.e7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients.
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Chaturvedi P, Worsley PR, Zanelli G, Kroon W, Bader DL. Quantifying skin sensitivity caused by mechanical insults: A review. Skin Res Technol 2022; 28:187-199. [PMID: 34708455 PMCID: PMC9298205 DOI: 10.1111/srt.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin sensitivity (SS) is a commonly occurring response to a range of stimuli, including environmental conditions (e.g., sun exposure), chemical irritants (e.g., soaps and cosmetics), and mechanical forces (e.g., while shaving). From both industry and academia, many efforts have been taken to quantify the characteristics of SS in a standardised manner, but the study is hindered by the lack of an objective definition. METHODS A review of the scientific literature regarding different parameters attributed to the loss of skin integrity and linked with exhibition of SS was conducted. Articles included were screened for mechanical stimulation of the skin, with objective quantification of tissue responses using biophysical or imaging techniques. Additionally, studies where cohorts of SS and non-SS individuals were reported have been critiqued. RESULTS The findings identified that the structure and function of the stratum corneum and its effective barrier properties are closely associated with SS. Thus, an array of skin tissue responses has been selected for characterization of SS due to mechanical stimuli, including: transepidermal water loss, hydration, redness, temperature, and sebum index. Additionally, certain imaging tools allow quantification of the superficial skin layers, providing structural characteristics underlying SS. CONCLUSION This review proposes a multimodal approach for identification of SS, providing a means to characterise skin tissue responses objectively. Optical coherence tomography (OCT) has been suggested as a suitable tool for dermatological research with clinical applications. Such an approach would enhance the knowledge underlying the multifactorial nature of SS and aid the development of personalised solutions in medical and consumer devices.
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Affiliation(s)
- Pakhi Chaturvedi
- Philips Consumer Lifestyle B.V.DrachtenThe Netherlands
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | | | | | - Wilco Kroon
- Philips Consumer Lifestyle B.V.DrachtenThe Netherlands
| | - Dan L. Bader
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Use of a Support Surface Standard to Test the Effects of a Turning and Positioning Device Versus Low-Air-Loss Therapy on Temperature and Humidity. Adv Skin Wound Care 2020; 33:S3-S10. [PMID: 32932289 DOI: 10.1097/01.asw.0000695744.57734.7c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Turning and repositioning devices (TRDs) help to reduce strain on caregivers, but clinicians question their effects on humidity and temperature (microclimate) at the skin surface that may increase risk of pressure ulcers. OBJECTIVE To pilot the use of a standard test for support surfaces to compare microclimate at the skin surface in three scenarios: (1) on a low-air-loss (LAL) surface, (2) on a representative TRD with a basic underpad (TRDU) placed on a LAL surface, and (3) on a negative control with full occlusion. The results are designed to inform clinical decision-making in using a TRD on a LAL surface and the viability of using this test to study TRDs. DESIGN Measuring humidity and temperature at the device-surface interface using a heated moisture-exuding bronze thermodynamic human model in a laboratory setting. MAIN OUTCOME MEASURE Humidity and temperature levels across 3 hours 15 minutes of continuous loading with a 45-second complete unloading to simulate a position change at 3 hours. MAIN RESULTS Relative humidity on the TRDU was below that on the LAL surface for the first 110 minutes and was markedly lower than the negative control for the remainder of humidity testing. Temperature on the TRDU was well below the negative control and negligibly higher than the surface alone throughout testing. The position change enhanced the effects of the TRDU. CONCLUSIONS The support surface standard test appears useful in evaluating TRDs. This TRD along with the basic underpad is more comparable to a LAL surface than to full occlusion in managing the microclimate of the skin and pressure ulcer risk.
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The effects of local cooling rates on perfusion of sacral skin under externally applied pressure in people with spinal cord injury: an exploratory study. Spinal Cord 2019; 58:476-483. [DOI: 10.1038/s41393-019-0378-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
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8
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Tzen YT, Brienza DM, Karg PE. Implementing local cooling to increase skin tolerance to ischemia during normal seating in people with spinal cord injury. J Tissue Viability 2019; 28:173-178. [PMID: 31587923 DOI: 10.1016/j.jtv.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/28/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to investigate the effectiveness of local cooling in reducing reactive hyperemia after ischemia at the ischial tuberosities for people with spinal cord injury (SCI) during normal seating. The degree of the reactive hyperemic response is indicative of the extent of cellular stress caused by the ischemia. We hypothesized that reactive hyperemic skin blood flow (SBF) responses will be lower when local cooling is implemented by the wheelchair seat cushion. This study used a repeated measures design, and each subject underwent two conditions: normal seating with temperature control 'on' (cooling) and 'off' (non-cooling) for 30 min. Twenty-three participants with traumatic SCI were recruited. SBF and skin temperature were collected before, during and after seating. SBF signals were processed with short-time Fourier analyses to examine the underlying vascular control mechanisms, including the following (corresponding frequency bands): metabolic (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), and myogenic (0.05-0.15 Hz) spectral densities. Our results showed that with cooling, skin temperature decreased (range -0.4 ~ -3.1 °C, p = 0.002), and reactive hyperemia parameters (normalized peak SBF and perfusion area) were reduced (p = 0.02, p = 0.033, respectively). In addition, changes in normalized peak SBF (non-cooling - cooling) was moderately correlated with changes in normalized metabolic and neurogenic spectral densities. Our findings suggested that local cooling has a positive effect on reducing the cellular stress caused by ischemia during normal seating. Metabolic and neurogenic SBF control mechanisms may play a minor role. Further exploration of the effect of temperature control on pressure injury prevention is warranted.
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Affiliation(s)
- Yi-Ting Tzen
- Department of Health Care Sciences, UT Southwestern Medical Center, USA; Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, USA; Department of Orthopedic Surgery, UT Southwestern Medical Center, USA.
| | - David M Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, USA
| | - Patricia E Karg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, USA
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Yapp JH, Raja Ahmad RMK, Mahmud R, Mohtarrudin N, Mohamad Yusof L, Abdul Rahim E, Ahmad SA, Abu Bakar MZ. Determining weight‐bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention. Wound Repair Regen 2019; 27:225-234. [DOI: 10.1111/wrr.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Jong Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Raja Mohd Kamil Raja Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Rozi Mahmud
- Cancer Resource and Education Center, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Ezamin Abdul Rahim
- Department of Imaging, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Md Zuki Abu Bakar
- Department of Veterinary Pre‐Clinical Science, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
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Using Multiscale Entropy to Assess the Efficacy of Local Cooling on Reactive Hyperemia in People with a Spinal Cord Injury. ENTROPY 2019; 21:e21010090. [PMID: 33266806 PMCID: PMC7514201 DOI: 10.3390/e21010090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
Abstract
Pressure ulcers are one of the most common complications of a spinal cord injury (SCI). Prolonged unrelieved pressure is thought to be the primary causative factor resulting in tissue ischemia and eventually pressure ulcers. Previous studies suggested that local cooling reduces skin ischemia of the compressed soft tissues based on smaller hyperemic responses. However, the effect of local cooling on nonlinear properties of skin blood flow (SBF) during hyperemia is unknown. In this study, 10 wheelchair users with SCI and 10 able-bodied (AB) controls underwent three experimental protocols, each of which included a 10-min period as baseline, a 20-min intervention period, and a 20-min period for recovering SBF. SBF was measured using a laser Doppler flowmetry. During the intervention period, a pressure of 60 mmHg was applied to the sacral skin, while three skin temperature settings were tested, including no temperature change, a decrease by 10 °C, and an increase by 10 °C, respectively. A multiscale entropy (MSE) method was employed to quantify the degree of regularity of blood flow oscillations (BFO) associated with the SBF control mechanisms during baseline and reactive hyperemia. The results showed that under pressure with cooling, skin BFO both in people with SCI and AB controls were more regular at multiple time scales during hyperemia compared to baseline, whereas under pressure with no temperature change and particularly pressure with heating, BFO were more irregular during hyperemia compared to baseline. Moreover, the results of surrogate tests indicated that changes in the degree of regularity of BFO from baseline to hyperemia were only partially attributed to changes in relative amplitudes of endothelial, neurogenic, and myogenic components of BFO. These findings support the use of MSE to assess the efficacy of local cooling on reactive hyperemia and assess the degree of skin ischemia in people with SCI.
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Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2018; 59:62-70. [PMID: 30199821 DOI: 10.1016/j.clinbiomech.2018.09.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humidity affect the structure and function of the skin increasing or lowering possible damage thresholds for the skin and underlying soft tissues. From a pressure ulcer prevention research perspective, the effects of humidity and temperature next to the skin surface are inextricably linked to concurrent soft tissue deformation. Direct clinical evidence supporting the association between microclimate and pressure ulceration is sparse and of high risk of bias. Currently, it is recommended to keep the skin dry and cool and/or to allow recovery periods between phases of occlusion. The stratum corneum must be prevented from becoming overhydrated or from drying out but exact ranges of an acceptable microclimate are unknown. Therefore, vague terms like 'microclimate management' should be avoided but product and microclimate characteristics should be explicitly stated to allow an informed decision making. Pressure ulcer prevention interventions like repositioning, the use of special support surfaces, cushions, and prophylactic dressings are effective only if they reduce sustained deformations in soft tissues. This mode of action outweighs possible undesirable microclimate properties. As long as uncertainty exists efforts must be taken to use as less occlusive materials as possible. There seems to be individual intrinsic characteristics making patients more vulnerable to microclimate effects.
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Local Cooling as a Step of Treatment for Tissue Ischemia Caused by Hyaluronic Acid Injection-induced Embolism-A Report of 9 Cases. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1824. [PMID: 30324052 PMCID: PMC6181502 DOI: 10.1097/gox.0000000000001824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Abstract
Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection-induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection-induced embolism and clinical cases are introduced in the article.
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Increased skin blood flow during low intensity vibration in human participants: Analysis of control mechanisms using short-time Fourier transform. PLoS One 2018; 13:e0200247. [PMID: 30001409 PMCID: PMC6042750 DOI: 10.1371/journal.pone.0200247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
Aim Investigate the immediate effect of low intensity vibration on skin blood flow and its underlying control mechanisms in healthy human participants. Materials and methods One-group pre-post design in a university laboratory setting. Nine adults underwent two bouts of 10-minute vibration (30Hz, peak acceleration 0.4g). Outcome measures include skin blood flow, and skin temperature on the right foot. To examine the control mechanisms underlying the vibration-induced blood flow response, SHORT-TIME Fourier analyses were computed to obtain the spectral densities for three frequency bands: metabolic (0.0095–0.02Hz), neurogenic (0.02–0.06Hz), and myogenic (0.06–0.15Hz). Non-parametric Friedman’s tests were computed to compare changes of the outcome measures and control mechanisms over the course of vibration. Results Vibration increased skin blood flow during both bouts of vibration, however the effect did not last after vibration was terminated. Myogenic spectral density increased during both bouts of vibration, whereas the metabolic and neurogenic spectral densities increased only during the 2nd bout of vibration. Interestingly, only the metabolic spectral density remained elevated after vibration ended. Conclusion Low intensity vibration produced acute increases in skin blood flow mediated in part by vascular control mechanisms of myogenic origin. Further investigation is warranted to determine whether low intensity vibration induces similar increases in skin blood flow in populations prone to developing chronic non-healing wounds, such as spinal cord injury and diabetes.
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Scheel-Sailer A, Frotzler A, Mueller G, Annaheim S, Rossi RM, Derler S. Biophysical skin properties of grade 1 pressure ulcers and unaffected skin in spinal cord injured and able-bodied persons in the unloaded sacral region. J Tissue Viability 2017; 26:89-94. [DOI: 10.1016/j.jtv.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/04/2016] [Accepted: 11/05/2016] [Indexed: 12/27/2022]
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15
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Yapp JH, Kamil R, Rozi M, Mohtarrudin N, Loqman MY, Ezamin AR, Ahmad SA, Abu Bakar Z. Trends of reactive hyperaemia responses to repetitive loading on skin tissue of rats - Implications for pressure ulcer prevention. J Tissue Viability 2017; 26:196-201. [PMID: 28438463 DOI: 10.1016/j.jtv.2017.03.002] [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] [Received: 11/07/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
Abstract
Tissue recovery is important in preventing tissue deterioration, which is induced by pressure and may lead to pressure ulcers (PU). Reactive hyperaemia (RH) is an indicator used to identify people at risk of PU. In this study, the effect of different recovery times on RH trend is investigated during repetitive loading. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385-485 g, were categorised into three groups and subjected to different recovery times with three repetitive loading cycles. The first, second, and third groups were subjected to short (3 min), moderate (10 min), and prolonged (40 min) recovery, respectively, while fixed loading time and pressure (10 min and 50 mmHg, respectively). Peak hyperaemia was measured in the three cycles to determine trends associated with different recovery times. Three RH trends (increasing, decreasing, and inconsistent) were observed. As the recovery time is increased (3 min vs. 10 min vs. 40 min), the number of samples with increasing RH trend decreases (57% vs. 29% vs. 14%) and the number of samples with inconsistent RH trend increases (29% vs. 57% vs. 72%). All groups consists of one sample with decreasing RH trend (14%). Results confirm that different recovery times affect the RH trend during repetitive loading. The RH trend may be used to determine the sufficient recovery time of an individual to avoid PU development.
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Affiliation(s)
- Jong-Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Raja Kamil
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia.
| | - M Rozi
- Cancer Resource and Education Center, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - M Y Loqman
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - A R Ezamin
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Zuki Abu Bakar
- Department of Veterinary Pre-Clinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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Hoogendoorn I, Reenalda J, Koopman BFJM, Rietman JS. The effect of pressure and shear on tissue viability of human skin in relation to the development of pressure ulcers: a systematic review. J Tissue Viability 2017; 26:157-171. [PMID: 28457615 DOI: 10.1016/j.jtv.2017.04.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
Pressure ulcers are a significant problem in health care, due to high costs and large impact on patients' life. In general, pressure ulcers develop as tissue viability decreases due to prolonged mechanical loading. The relation between load and tissue viability is highly influenced by individual characteristics. It is proposed that measurements of skin blood flow regulation could provide good assessment of the risk for pressure ulcer development, as skin blood flow is essential for tissue viability. . Therefore, the aim of this systematic review is to gain insight in the relation between mechanical load and the response of the skin and underlying tissue to this loading measured in-vivo with non-invasive techniques. A systematic literature search was performed to identify articles analysing the relation between mechanical load (pressure and/or shear) and tissue viability measured in-vivo. Two independent reviewers scored the methodological quality of the 22 included studies. Methodological information as well as tissue viability parameters during load application and after load removal were extracted from the included articles and used in a meta-analysis. Pressure results in a decrease in skin blood flow parameters, compared to baseline; showing a larger decrease with higher magnitudes of load. The steepness of the decrease is mostly dependent on the anatomical location. After load removal the magnitude of the post-reactive hyperaemic peak is related to the magnitude of pressure. Lastly, shear in addition to pressure, shows an additional negative effect, but the effect is less apparent than pressure on skin viability.
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Affiliation(s)
- Iris Hoogendoorn
- Faculty of Engineering Technology/ MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands.
| | - Jasper Reenalda
- Faculty of Engineering Technology/ MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands
| | - Bart F J M Koopman
- Faculty of Engineering Technology/ MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Johan S Rietman
- Faculty of Engineering Technology/ MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands
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Lee B, Benyajati S, Woods JA, Jan YK. Effect of local cooling on pro-inflammatory cytokines and blood flow of the skin under surface pressure in rats: feasibility study. J Tissue Viability 2014; 23:69-77. [PMID: 24513091 DOI: 10.1016/j.jtv.2014.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/18/2013] [Accepted: 01/16/2014] [Indexed: 01/11/2023]
Abstract
The primary purpose of this feasibility study was to establish a correlation between pro-inflammatory cytokine accumulation and severity of tissue damage during local pressure with various temperatures. The secondary purpose was to compare skin blood flow patterns for assessing the efficacy of local cooling on reducing skin ischemia under surface pressure. Eight Sprague-Dawley rats were assigned to two protocols, including pressure with local cooling (Δt = -10 °C) and pressure with local heating (Δt = 10 °C). Pressure of 700 mmHg was applied to the right trochanter area of rats for 3 h. Skin perfusion quantified by laser Doppler flowmetry and TNF-∗ and IL-1β levels were measured. Our results showed that TNF-α concentrations were increased more significantly with local heating than with local cooling under pressure whereas IL-1β did not change. Our results support the notion that weight bearing soft tissue damage may be reduced through temperature modulation and that non-invasive perfusion measurements using laser Doppler flowmetry may be capable of assessing viability. Furthermore, these results show that perfusion response to loading pressure may be correlated with changes in local pro-inflammatory cytokines. These relationships may be relevant for the development of cooling technologies for reducing risk of pressure ulcers.
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Affiliation(s)
- Bernard Lee
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Siribhinya Benyajati
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jeffrey A Woods
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Liao F, O’Brien WD, Jan YK. Assessing complexity of skin blood flow oscillations in response to locally applied heating and pressure in rats: implications for pressure ulcer risk. PHYSICA A 2013; 392:10.1016/j.physa.2013.06.007. [PMID: 24319315 PMCID: PMC3849034 DOI: 10.1016/j.physa.2013.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to investigate the effects of local heating on complexity of skin blood flow oscillations (BFO) under prolonged surface pressure in rats. Eleven Sprague-Dawley rats were studied: 7 rats underwent surface pressure with local heating (Δt = 10 °C) and 4 rats underwent pressure without heating. A pressure of 700 mmHg was applied to the right trochanter area of rats for 3 h. Skin blood flow was measured using laser Doppler flowmetry. The loading period was divided into nonoverlapping 30 min epochs. For each epoch, multifractal detrended fluctuation analysis (MDFA) was utilized to compute DFA coefficients and complexity of endothelia related metabolic, neurogenic, and myogenic frequencies of BFO. The results showed that under surface pressure, local heating led to a significant decrease in DFA coefficients of myogenic frequency during the initial epoch of loading period, a sustained decrease in complexity of myogenic frequency, and a significantly higher degree of complexity of metabolic frequency during the later phase of loading period. Surrogate tests showed that the reduction in complexity of myogenic frequency was associated with a loss of nonlinearity whereas increased complexity of metabolic frequency was associated with enhanced nonlinearity. Our results indicate that increased metabolic activity and decreased myogenic response due to local heating manifest themselves not only in magnitudes of metabolic and myogenic frequencies but also in their structural complexity. This study demonstrates the feasibility of using complexity analysis of BFO to monitor the ischemic status of weight-bearing skin and risk of pressure ulcers.
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Affiliation(s)
- Fuyuan Liao
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - William D. O’Brien
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Yih-Kuen Jan
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
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Using Reactive Hyperemia to Assess the Efficacy of Local Cooling on Reducing Sacral Skin Ischemia Under Surface Pressure in People With Spinal Cord Injury: A Preliminary Report. Arch Phys Med Rehabil 2013; 94:1982-9. [DOI: 10.1016/j.apmr.2013.03.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 02/18/2013] [Accepted: 03/25/2013] [Indexed: 11/21/2022]
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Tzen YT, Brienza DM, Karg PE, Loughlin PJ. Effectiveness of local cooling for enhancing tissue ischemia tolerance in people with spinal cord injury. J Spinal Cord Med 2013; 36:357-64. [PMID: 23820151 PMCID: PMC3758532 DOI: 10.1179/2045772312y.0000000085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the effects of localized cooling and cooling rate on pressure-induced ischemia for people with and without neurological deficits. DESIGN A 2 × 3 mixed factorial design with two groups: (1) people with spinal cord injury (SCI) and (2) people without neurological deficits (control), and three test conditions: (1) pressure only, (2) pressure with fast cooling (-4°C/min), and (3) pressure with slow cooling (-0.33°C/min). SETTING University laboratory. PARTICIPANTS Fourteen controls and 14 individuals with SCI. INTERVENTIONS Pressure on the sacrum was 0.4 kPa for 5 minutes, then 8 kPa for 20 minutes, and finally 0.4 kPa for 15 minutes. Fast and slow cooling to 25°C applied during 8 kPa of pressure. OUTCOME MEASURES Reactive hyperemia and its spectral densities in the metabolic, neurogenic, and myogenic frequency ranges. RESULTS In controls, reactive hyperemia was greater in pressure only as compared with both cooling conditions. No change was noted in all spectral densities in both cooling conditions, and only neurogenic spectral density increased without cooling. In subjects with SCI, no difference was noted in reactive hyperemia among conditions. However, metabolic and myogenic spectral densities increased without cooling and all spectral densities increased with slow cooling. No change was noted in all spectral densities with fast cooling. CONCLUSION Local cooling reduced the severity of ischemia in controls. This protective effect may be masked in subjects with SCI due to chronic microvascular changes; however, spectral analysis suggested local cooling may reduce metabolic vasodilation. These findings provide evidence towards the development of support surfaces with temperature control for weight-bearing soft tissues.
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Affiliation(s)
- Yi-Ting Tzen
- University of Pittsburgh, Pittsburgh, PA 15206, USA.
| | - David M. Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patricia E. Karg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Jan YK, Lee B, Liao F, Foreman RD. Local cooling reduces skin ischemia under surface pressure in rats: an assessment by wavelet analysis of laser Doppler blood flow oscillations. Physiol Meas 2012; 33:1733-45. [PMID: 23010955 DOI: 10.1088/0967-3334/33/10/1733] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objectives of this study were to investigate the effects of local cooling on skin blood flow response to prolonged surface pressure and to identify associated physiological controls mediating these responses using the wavelet analysis of blood flow oscillations in rats. Twelve Sprague-Dawley rats were randomly assigned to three protocols, including pressure with local cooling (Δt = -10 °C), pressure with local heating (Δt = 10 °C) and pressure without temperature changes. Pressure of 700 mmHg was applied to the right trochanter area of rats for 3 h. Skin blood flow was measured using laser Doppler flowmetry. The 3 h loading period was divided into non-overlapping 30 min epochs for the analysis of the changes of skin blood flow oscillations using wavelet spectral analysis. The wavelet amplitudes and powers of three frequencies (metabolic, neurogenic and myogenic) of skin blood flow oscillations were calculated. The results showed that after an initial loading period of 30 min, skin blood flow continually decreased under the conditions of pressure with heating and of pressure without temperature changes, but maintained stable under the condition of pressure with cooling. Wavelet analysis revealed that stable skin blood flow under pressure with cooling was attributed to changes in the metabolic and myogenic frequencies. This study demonstrates that local cooling may be useful for reducing ischemia of weight-bearing soft tissues that prevents pressure ulcers.
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Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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