The effectiveness of curvilinear supine position on the incidence of pressure injuries and interface pressure among surgical patients

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.

Pressure Injury Risk Assessment and the Use of Intraoperative Polyurethane Foams to Prevent the Pressure Injuries

BACKGROUND: Patients undergoing surgery are at risk of developing pressure sores up to 72 h after surgery. The incidence of pressure injury can affect patient outcomes and quality of care. Pressure injuries have many risk factors and causes. The Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients was used to assess risk factors for developing a pressure injury. One of the interventions to prevent pressure injuries during and after surgery is polyurethane foams. AIM: The study aimed to describe the risk of pre-operative pressure injury, the use of intraoperative polyurethane foams, and the incidence of post-operative pressure injury in a private hospital in western Indonesia. METHODS: A cross-sectional quantitative descriptive study was conducted among 81 patients undergoing surgery using purposive sampling. The pre-operative risk assessment was conducted with the Munro scale for the pre-operative phase. The use of polyurethane foams during surgery and pressure injury incidence was observed. RESULTS: The results showed that 62 (76.5%) respondents were at moderate risk for pressure injury. 42 (51.9%) respondents used polyurethane foams in the intraoperative phase. Based on observation 72 h postoperatively, there was no pressure injury incidence. CONCLUSION: Pressure injuries can be prevented by identifying risk factors before the surgery. Nurses and surgeons need to be aware of the risk of pressure ulcers in the pre-, inter-, and post-operative phases. The use of polyurethane foams during surgery can be considered an intervention to prevent pressure injury.

A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler's Position

Insufficient research exists for position change intervals to eradicate pressure ulcers. We tried to provide evidence for the position change interval by comparing peak pressure, risk area ratio, and the time to reach 30 mmHg and 60 mmHg, and presented this in detail, according to the angle in the three positions. The study conducted RCTs on a total of 64 healthy adults. For two hours, interface pressure measurements were compared with 30° and 90° tilting at the inclined, 0° and 45° head-of-bed (HOB) elevation at the supine, and 30° and 45° HOB elevation at the Fowler’s position. The peak pressure on 30° tilting remained less than 60 mmHg for 2 h, unlike 90° tilting. To reach 60 mmHg took 78.18 min at 30° tilting, within 30 min at the 30° supine, 30° and 45° at the Fowler’s position, and 39.55 min at 0° supine. The pressure difference according to the angles was only significant at 30° and 90° tilting, with no difference in the other groups. To prevent pressure ulcers, position changes are required every 2 h in the 30° tilting position, every 1.5 to 2 h at 0° supine, and at least every 1.5 h for all the other positions.

Effects of 45° prone position ventilation in the treatment of acute respiratory distress syndrome: A protocol for a randomized controlled trial study

BACKGROUND

Acute respiratory distress syndrome (ARDS) is an increasingly common acute respiratory failure that seriously threaten people's health. ARDS has a case fatality rate of up to 40%. ARDS is a serious threat to the life safety of patients and the quality of life, causing a huge economic burden to individuals, families and society. ARDS has become a large worldwide public health problem. Prone position ventilation (PPV) is an important auxiliary treatment for ARDS, which could improve oxygenation. However, PPV could cause Pressure injuries (PI) and other complications easily. We found that 45° PPV could reduce the incidence of PI, but lack of robust Evidence-based medicine evidence proving its efficacy. Therefore, we designed a randomized controlled trial to evaluate the efficacy of 45° PPV in the treatment of ARDS.

METHODS

A total of 268 patients will be randomly assigned to the control group and the test group (n = 134 each) in a ratio of 1:1. The treatment period is 7 days. The primary outcome measure will be the incidence of PI. The secondary outcomes will include APACHE II score, Braden Scale score, heart rate, systolic blood pressure, diastolic blood pressure, central venous pressure, mean arterial pressure, pH of arterial blood, oxygenation index, oxygen partial pressure, and carbon dioxide partial pressure. The evaluation will be performed at baseline, 1 hour, 12 hour, 48 hour, 5days, 7days after PPPV.

RESULTS

This study is helpful to evaluate the efficacy of 45° PPV in the treatment of ARDS.

CONCLUSION

45° PPV may reduce the incidence of PI and improve oxygenation in patients with ARDS, which has important value in practical application.

TRIAL REGISTRATION

ChiCTR2000040436, registration time: November 28, 2020.