Pressure levels in the trochanter area according to repositioning at different degrees of inclination in healthy subjects

Associations between body mass index and interface pressure after 3 h loading in healthy adults

AIM OF THE STUDY

The purpose of this study was to determine the associations between body mass index and interface pressure after 3 h loading in healthy adults and to establish a foundation for the development of interventions tailored to body mass index.

MATERIAL AND METHODS

A secondary data analysis based on a clinical trial involving 75 adults was conducted. Data were analyzed using descriptive statistics, repeated measure ANOVA, and ANCOVA. The statistics program IBM SPSS Statistics 27.0 was used for data analysis.

RESULTS

Loading caused a significant increase in average pressure in the obesity group compared to the underweight group. There was a significant increase in risk area ratio calculated based on 30 mmHg and 45 mmHg in both obesity and overweight groups compared to the underweight group. On both support surfaces, average pressure, peak pressure, and risk area ratio were higher in the obese group compared to the normal weight group. However, these differences were not statistically significant.

CONCLUSION

Given the emphasized risk of pressure injuries, long-term observation of body mass index-specific changes in interface pressure can provide crucial evidence for pressure injury prevention nursing. The results of this study suggest the need to implement pressure injury prevention interventions that consider the pressure characteristics according to BMI.

Exploring body morphology, sacral skin microclimate and pressure injury development and risk among patients admitted to an intensive care unit: A prospective, observational study

OBJECTIVE

To determine the association between body morphology, sacral skin microclimate and their impact on the development and risk of pressure injuries among patients in an intensive care unit.

METHODOLOGY

A prospective observational exploratory study was conducted over 30 weeks. Repeat study observations occurred multiple times a week for 28 days or until discharge. Participant inclusion criteria were ≥ 18 years of age, expected intensive care length of stay > 24 h and intact skin over the sacrum region.

SETTING

The study was conducted in a 36-bed intensive care unit of a major metropolitan public hospital in Queensland, Australia.

OUTCOME MEASURES

Pressure injuries were staged and independently verified according to the international pressure injury classification system. Pressure injury risk was determined by the Braden scale score and subepidermal oedema, using a subepidermal moisture scanner at the sacrum.

RESULTS

Of the 93 participants recruited, an inverted triangle body shape (p =.049), a BMI > 25 kg/m2 (p =.008), a standard foam mattress type (p =.017) and increased length of stay (p <.001) were associated with an increased pressure injury risk according to subepidermal oedema. Participants with increased sacral skin temperature (p <.001), mechanical ventilation (p <.001), vasoactive drugs administered (p =.003), increased sequential organ failure assessment score (p =.047), neurovascular diagnosis (p =.031) and increased length of stay (p =.027) were associated with increased pressure injury risk according to the Braden scale score.

CONCLUSION

Body morphology and skin microclimate are associated with pressure injury risk during critical illness.

IMPLICATIONS FOR CLINICAL PRACTICE

Subepidermal oedema was associated with a patient's shape, body mass index and mattress type, factors that directly influence the pressure loading and the skin, whereas the Braden scale was associated with sacral temperature and clinical measures of critical illness. Consideration of body morphology and skin microclimate in pressure injury risk assessment could lead to more specific prevention strategies targeting high risk patients.

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.

Tissue temperature, flux and oxygen of sacral and trochanteric area under pressure of healthy subjects: A quasi-experimental study

AIM

To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h.

METHODS

Quasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements.

RESULTS

The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant.

CONCLUSION

Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.