Interface pressure mapping pilot study to select surfaces that effectively redistribute pediatric occipital pressure

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study

The prevention of hospital‐acquired pressure injuries (HAPIs) in children undergoing long‐duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long‐duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi‐modal, multi‐disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long‐duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long‐duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence‐based, multi‐modal, multidisciplinary HAPI prevention strategy.

Evaluating pressure redistribution surfaces for the occiput

OBJECTIVE

Patients hospitalised in the Burn Intensive Care Unit are at increased risk of pressure ulcers (PU; also known as pressure injuries). While effective methods exist to offload pressure from other areas, offloading the head is difficult, especially with facial or head burns. An increase in occipital PUs prompted a review of practices for offloading the head in the Burn Intensive Care Unit.

METHOD

A multidisciplinary team (MDT) of physicians, occupational therapists and nurses evaluated several devices used to prevent occipital PUs using a pressure mapping device. Pressure was measured using the SensorEdge Measure X device. The pressure mapping device provides a real-time graphic representation of pressure to the body area studied, in this case the occiput. In addition, the SensorEdge allows for numeric data to be exported to Excel format.

RESULTS

Our data showed that the occipital pressure was observed in our health volunteer using a fluidised gel positioner using pressure mapping. As a result of this we stopped using other pillows and went to exclusive use of the fluidised gel positioner. Reimplementation and consistent use of a fluidised gel positioner resulted in decreasing occipital PUs from nine to zero.

CONCLUSION

The use of a fluidised gel positioner should be considered in other critical care environments to reduce the prevalence of hospital acquired occipital PUs.

Active Body Pressure Relief System with Time-of-Flight Optical Pressure Sensors for Pressure Ulcer Prevention

A body pressure relief system was newly developed with optical pressure sensors for pressure ulcer prevention. Unlike a conventional alternating pressure air mattress (APAM), this system automatically regulates air flow into a body supporting mattress with adaptive inflation (or deflation) duration in response to the pressure level in order to reduce skin stress due to prolonged high pressures. The system continuously quantifies the body pressure distribution using time-of-flight (ToF) optical sensors. The proposed pressure sensor, a ToF optical sensor in the air-filled cell, measures changes in surface height of mattress when pressed under body weight, thereby indirectly indicating the interface pressure. Non-contact measurement of optical sensor usually improves the durability and repeatability of the system. The pressure sensor was successfully identified the 4 different-predefined postures, and quantitatively measured the body pressure distribution of them. Duty cycle of switches in solenoid valves was adjusted to 0–50% for pressure relief, which shows that the interface pressure was lower than 32 mmHg for pressure ulcer prevention.

Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation

OBJECTIVE

To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR.

METHODS

This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates.

RESULTS

We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091).

CONCLUSIONS

Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.

Pressure Redistribution Crib Mattress: A Quality Improvement Project

BACKGROUND

Selective use of pressure-redistributing support surfaces is considered an essential component of a pressure injury prevention bundle. Critically ill children who are too big for an isolette but too little for a bed are usually placed in critical care cribs that have unique features such as moveable side rails and a built-in scale for weighing the patient, but they do not have a mattress designed to redistribute pressure. The primary aim of this quality improvement project was to evaluate a pressure redistribution mattress designed for use in critical care cribs.

CASES

We retrospectively reviewed 22 charts of critically ill pediatric patients who participated in a product trial completed over a 12-week period in a stand-alone children's hospital in the Western United States. We reviewed demographic data, skin assessments, Braden Q Scale score, and support surface use. Our review revealed no pressure injury occurrences over the 12-week data collection period.

CONCLUSIONS

Findings from this quality improvement project suggest that the pressure-redistributing mattress, when used as part of an intervention bundle, prevents pressure injuries in critically ill pediatric patients.

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post-test design with a historical control group was used in a 54-bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty-four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger-scale study.

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.

Pressure Injuries in Medically Complex Children: A Review

Pressure injuries are a challenging problem in the care of medically complex children. Available evidence is limited, and there are theoretical reasons to use caution before extrapolating adult data, including key differences in body composition, common locations of pressure injury, and association with medical devices. The focus of this article will be to review the definition of a pressure injury and what is known about pathophysiology, prevention, recognition, staging, and treatment of pressure injuries in children with medical complexity.