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Kebapci A, Tilki R. The effect of vasopressor agents on pressure injury development in intensive care patients. Intensive Crit Care Nurs 2024; 83:103630. [PMID: 38479195 DOI: 10.1016/j.iccn.2024.103630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Vasopressors are life-saving agents that increase mean arterial pressure. The pharmacodynamic features of these agents and previous studies suggest that vasopressors may be an essential risk factor in developing pressure injuries. OBJECTIVE This study aimed to examine the effect of vasopressors in medical-surgical intensive care patients on pressure injury development. DESIGN AND SETTINGS This retrospective and correlational study was conducted between March 2021- May 2022. The electronic patient data were obtained from 148 surgical and medical patients exposed to vasopressor agents in the intensive care unit. Data on patients' demographic and clinical characteristics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Logistic regression modelling was used to assess independent relationships with pressure injury risk; results are reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS All patients were given norepinephrine agents, and dopamine infusion secondary to norepinephrine was found in only 28.3 % of patients (n = 42). Pressure injury incidence was 43.2 % (n = 64). Duration of norepinephrine infusion was recognized as an independent risk factor for ICU-acquired pressure injury development (OR 1.22, 95 % CI 1.11-1.35), while a medical admission diagnosis (instead of surgical) was protective against pressure injury risk (OR 0.24, 95 % CI 0.10-0.59). CONCLUSION This study indicated that duration of norepinephrine infusion is a significant risk factor for pressure injury development. IMPLICATIONS FOR CLINICAL PRACTICE Although norepinephrine use cannot be avoided entirely, its administration may be an early warning for nurses to increase pressure injury prevention strategies. Skin evaluation should be performed more frequently, and preventive strategies should be implemented meticulously. This study was registered on clincialtrials.gov (Identifier: NCT06163352).
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Affiliation(s)
- Ayda Kebapci
- Koç University School of Nursing, Koç University Hospital, Davutpaşa Cad. No: 4, Topkapı, Istanbul, Türkiye.
| | - Ruhat Tilki
- Koç University School of Health Sciences, Davutpaşa Cad. No: 4 Koç Üniversitesi Hastanesi, Topkapı, Istanbul, Turkey
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Emami Zeydi A, Zare‐Kaseb A, Nazari AM, Ghazanfari MJ, Sarmadi S. Mask-related pressure injury prevention associated with non-invasive ventilation: A systematic review. Int Wound J 2024; 21:e14909. [PMID: 38826030 PMCID: PMC11144948 DOI: 10.1111/iwj.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.
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Affiliation(s)
- Amir Emami Zeydi
- Department of Medical‐Surgical Nursing, Nasibeh School of Nursing and MidwiferyMazandaran University of Medical SciencesSariIran
| | - Akbar Zare‐Kaseb
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Amir Mohamad Nazari
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Javad Ghazanfari
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Sogand Sarmadi
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
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Reese TJ, Domenico HJ, Hernandez A, Byrne DW, Moore RP, Williams JB, Douthit BJ, Russo E, McCoy AB, Ivory CH, Steitz BD, Wright A. Implementable Prediction of Pressure Injuries in Hospitalized Adults: Model Development and Validation. JMIR Med Inform 2024; 12:e51842. [PMID: 38722209 PMCID: PMC11094428 DOI: 10.2196/51842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Numerous pressure injury prediction models have been developed using electronic health record data, yet hospital-acquired pressure injuries (HAPIs) are increasing, which demonstrates the critical challenge of implementing these models in routine care. Objective To help bridge the gap between development and implementation, we sought to create a model that was feasible, broadly applicable, dynamic, actionable, and rigorously validated and then compare its performance to usual care (ie, the Braden scale). Methods We extracted electronic health record data from 197,991 adult hospital admissions with 51 candidate features. For risk prediction and feature selection, we used logistic regression with a least absolute shrinkage and selection operator (LASSO) approach. To compare the model with usual care, we used the area under the receiver operating curve (AUC), Brier score, slope, intercept, and integrated calibration index. The model was validated using a temporally staggered cohort. Results A total of 5458 HAPIs were identified between January 2018 and July 2022. We determined 22 features were necessary to achieve a parsimonious and highly accurate model. The top 5 features included tracheostomy, edema, central line, first albumin measure, and age. Our model achieved higher discrimination than the Braden scale (AUC 0.897, 95% CI 0.893-0.901 vs AUC 0.798, 95% CI 0.791-0.803). Conclusions We developed and validated an accurate prediction model for HAPIs that surpassed the standard-of-care risk assessment and fulfilled necessary elements for implementation. Future work includes a pragmatic randomized trial to assess whether our model improves patient outcomes.
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Affiliation(s)
- Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antonio Hernandez
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel W Byrne
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan P Moore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jessica B Williams
- Department of Nursing, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brian J Douthit
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elise Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine H Ivory
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Yilmaz Akyaz D, Cevizci T, Sengul T. Everyday Prevention: The Impact of Daily Comprehensive Skin Assessments on Pressure Injury Healing in the General ICU. Adv Skin Wound Care 2024; 37:248-253. [PMID: 38648237 DOI: 10.1097/asw.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To investigate the effect of daily versus weekly comprehensive skin assessments on wound healing status in patients with pressure injuries (PIs) treated in the general ICU. METHODS This quasi-experimental study was conducted at a foundation hospital from November 15, 2022, to March 15, 2023. The sample consisted of 193 patients with PIs who met the inclusion criteria. The Braden Scale, Nutritional Risk Scale 2002 (NRS-2002), and Pressure Ulcer Scale for Healing (PUSH) were used. The intervention group (n = 98) underwent comprehensive skin assessment every day, whereas the control group (n = 95) followed routine procedures. The study findings were reported according to TREND (Transparent Reporting of Evaluations with Non-randomized Designs) guidelines. RESULTS Patients were older adults, with a mean age of 70 ± 15.45 years in the intervention group and 71 ± 13.20 years in the control group. The mean NRS-2002 score was 3 ± 2.01 in the intervention group and 2 ± 1.38 in the control group. Medical device-related PI incidence was high in both groups (intervention: 36.8%, control: 24.5%). In the intervention (14.3%) and control (50%) groups, PIs developed mostly due to antiembolic stockings. Deep-tissue PIs were the most common (intervention: 56.8%, control: 62.2%). The last PUSH scores decreased in both groups. The difference between the PUSH scores of the intervention and control groups was statistically significant (P < .05). CONCLUSIONS The findings of this study demonstrate the critical role of daily comprehensive skin assessment in the healing process of PIs. Especially in ICUs, the study provides compelling evidence for the need to prioritize and implement regular skin assessments to prevent PIs and support the healing process.
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Affiliation(s)
- Dilek Yilmaz Akyaz
- At Koç University Hospital, İstanbul, Turkey, Dilek Yilmaz Akyaz, MSc, RN, and Tugba Cevizci, RN, are Wound and Ostomy Care Nurses. Tuba Sengul, PhD, RN, CWON, is Associate Professor, Koç University. Acknowledgments: The authors thank all institutions and Sena Sukran Gura, Busra Serap Seyyar, and Nihan Tiryakioglu for their contributions to the study. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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Alshahrani B, Middleton R, Rolls K, Sim J. Pressure injury prevalence in critical care settings: An observational pre-post intervention study. Nurs Open 2024; 11:e2110. [PMID: 38391102 PMCID: PMC10847625 DOI: 10.1002/nop2.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/11/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To explore pressure injury prevention practices and evaluate the impact of an educational intervention on PI prevalence before and after an educational intervention. DESIGN A multi-centre observational study. METHOD Data were collected at two time points in May 2021 and April 2022 using a Qualtrics® online form. Two Registered Nurses at each site collected observational data at each time point by diagnosing and staging any identified pressure injuries as part of a prevalence study. Patients admitted to participating units were included. RESULTS A total of 181 patients in critical care units were included at the two-time points. Pressure injury prevalence was 60.9% at the outset, with 52.9% hospital-acquired, 37.9% unit-acquired and 23.0% medical device-related. Post-intervention prevalence decreased significantly to 28.7%, including 21.3% hospital-acquired, 14.9% unit-acquired, and 8.5% medical device-related. Pressure injuries were prominent in the sacral region, head area, and heels. Stages I and II pressure injuries were the most common. Increased age and longer ICU stays are linked to a heightened risk of pressure injury development in critically ill patients, whereas higher haemoglobin levels show an inverse relationship with the development of both pressure injury and severe stages in the univariate analysis. The predictive models revealed that increased age and longer ICU stays are predictors for both pressure injury development and progression to severe stages, while Braden scores predict the likelihood of developing severe stages of pressure injuries. CONCLUSIONS This study has identified a benchmark for pressure injury prevalence in critical care units in Saudi Arabia. The results demonstrate that pressure injuries can be prevented in critically ill patients when evidence-based education strategies are implemented. PATIENT CARE IMPACT Pressure injuries are an important issue for critically ill patients and can be prevented with proper investments. Strategies to prevent pressure injuries from admission will result in fewer pressure injuries. REPORTING METHOD Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and the Template for Intervention Description and Replication (TIDieR) checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Bassam Alshahrani
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNSWAustralia
- Taibah UniversityMadinahSaudi Arabia
| | - Rebekkah Middleton
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNSWAustralia
| | - Kaye Rolls
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNSWAustralia
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNSWAustralia
- WHO Collaborating Centre for Nursing, Midwifery & Health DevelopmentUniversity of Technology SydneySydneyNSWAustralia
- School of Nursing & MidwiferyUniversity of NewcastleCallaghanNew South WalesAustralia
- School of Nursing, Midwifery & ParamedicineAustralian Catholic UniversityNorth SydneyNSWAustralia
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Lu W, Bloom O, Rathgeber M, Maltser S. Pressure injury prevalence and characteristics in patients with COVID-19 admitted to acute inpatient rehabilitation unit. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1058982. [PMID: 37077291 PMCID: PMC10106692 DOI: 10.3389/fresc.2023.1058982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023]
Abstract
ObjectiveTo investigate the incidence and severity of pressure injuries among COVID-19 patients who required acute hospitalization and subsequent acute inpatient rehabilitation (AIR).DesignData was collected retrospectively from medical charts of COVID-19 patients who were admitted to AIR during April 2020–April 2021.SettingAcute Inpatient Rehabilitation at a single hospital in the greater New York metropolitan area.ParticipantsSubjects included COVID-19 patients (N = 120) who required acute hospitalization and subsequent acute inpatient rehabilitation, of whom 39 (32.5%) had pressure injuries.InterventionsNot applicable.Main outcome measure(s)The incidence, location, and severity of pressure injuries in COVID-19 patients, as well as demographic and clinical characteristics of the acute hospitalization.ResultsAmong patients who developed pressure injuries, more patients received mechanical ventilation (59% vs. 33%, P < 0.05) and tracheostomy (67% vs. 17%, P < 0.00001). The lengths of stay were longer in both the intensive care unit (ICU) (34 vs. 15 days, P < 0.005), and in acute inpatient rehabilitation (22 vs. 17 days P < 0.05).ConclusionPressure injuries were more common in COVID-19 patients who had longer lengths of stay, received mechanical ventilation or tracheostomy, during acute hospitalization. This supports the use of protocols to prioritize pressure offloading in this patient population.
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Affiliation(s)
- Weiying Lu
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Ona Bloom
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institute for Medical Research, New York, NY, United States
| | - Melissa Rathgeber
- Department of Rehabilitation Services, Northwell Health, New York, NY, United States
| | - Susan Maltser
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
- Correspondence: Susan Maltser
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Elsorady KE, Nouh AH. Biomarkers and clinical features associated with pressure injury among geriatric patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
<b>Purpose:</b> The study aims to identify biomarkers and clinical features associated with pressure injury (PI) among geriatric patients.<br />
<b>Methods:</b> A cross-sectional study including 191 patients aged ≥60 years. Patients were classified into those with and without PI. Assessing the risk of PI was performed on admission by applying the Braden scale (BS) for predicting pressure sore risk. Clinical history, baseline hematology, and biochemistry results were obtained. C-reactive protein to albumin ratio (CAR) and Charlson comorbidity index (CCI) were calculated. Statistical analyses were performed.<br />
<b>Results: </b>43 (22.5%) patients had PI. PI was significantly associated with higher CCI, total leukocyte count, and CAR, besides lower BS scores, serum albumin, and total proteins. Significant comorbidities were diabetes mellitus, stroke/transient ischemic attack, dementia, incontinence, and chronic kidney disease. The optimal cut-offs for PI occurrence were ≤14, ≤3.1 g/dl and >1.27 for BS, albumin, and CAR, respectively.
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Affiliation(s)
- Khalid Elsayed Elsorady
- Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, EGYPT
- Geriatrics Hospital, Ain Shams University Hospitals, Abbasia, Cairo, EGYPT
| | - Ahmed Hassan Nouh
- Department of Dermatology and Venereology, Al Azhar University, Cairo, EGYPT
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Numerical simulation-based loaded inflation height modeling of nursing bed airbag. Med Biol Eng Comput 2022; 60:3231-3242. [DOI: 10.1007/s11517-022-02671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
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Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:211-219. [PMID: 35523235 PMCID: PMC9093720 DOI: 10.1097/won.0000000000000878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units. RESULTS Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups. CONCLUSION Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.
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Affiliation(s)
- Laura E. Edsberg
- Correspondence: Laura E. Edsberg, PhD, Center for Wound Healing Research, Daemen University, 4380 Main St, Amherst, NY 14226 ()
| | - Jill Cox
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Kimberly Koloms
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Catherine A. VanGilder-Freese
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
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Alderden J, Amoafo L, Zhang Y, Fife C, Yap D, Yap T. Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study. JMIR DERMATOLOGY 2021; 4:e29757. [PMID: 37632818 PMCID: PMC10334951 DOI: 10.2196/29757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the "outside in" as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the "inside out" due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device-related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.
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Affiliation(s)
| | - Linda Amoafo
- University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- University of Utah, Salt Lake City, UT, United States
| | | | - David Yap
- University of Utah, Salt Lake City, UT, United States
| | - Tracey Yap
- Duke University, Durham, NC, United States
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Yoshimura de Campos MM, Souza MFCD, Whitaker IY. Riesgo de úlceras por presión (UPP) en pacientes internados en las unidades de cuidados intensivos. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Las limitaciones de la percepción sensorial, la inmovilidad, la sedación, la ventilación mecánica, la hipoperfusión tisular, el edema y la humedad se consideran factores que predisponen la aparición de úlceras por presión en pacientes en estado crítico. Objetivo: Caracterizar las úlceras por presión en pacientes críticos, determinar la asociación con variables demográficas, la hospitalización y las condiciones clínicas, e identificar los factores de riesgo para la aparición de úlceras por presión. Materiales y Métodos: Se realizó un estudio transversal mediante una muestra de pacientes > 18 años que no presentaban úlceras por presión al ingreso y habían estado hospitalizados >24 horas en la Unidad de Cuidados Intensivos. La asociación de las úlceras por presión con las variables se verificó a través de la prueba U de Mann-Whitney, prueba de chi-cuadrado, razón de verosimilitud y el test exacto de Fisher. Los factores de riesgo se identificaron mediante regresión logística múltiple. Resultados: De 324 pacientes, 46 (14.2%) desarrollaron úlceras por presión con mayor frecuencia en las regiones sacra y calcánea. Los factores de riesgo para la aparición de úlceras por presión fueron la edad, la duración de la hospitalización y la estancia hospitalaria antes de ingresar a la Unidad de Cuidados Intensivos. Discusión: La alta incidencia, la localización y el estadio de las úlceras por lesión observadas revelan la vulnerabilidad del paciente de la unidad de cuidados intensivos a este tipo de lesiones. Entre los riesgos de las úlceras por presión se encuentran factores relacionados con el paciente, la hospitalización y la gravedad de la enfermedad, y su combinación debe valorarse en la evaluación diaria del paciente crítico. Conclusión: La aparición de úlceras por presión en pacientes críticos es un fenómeno multifactorial, para la que el reconocimiento de factores de riesgo puede contribuir a una rápida adopción de medidas para su prevención
Como citar este artículo: Campos, Michelle Mayumi Yoshimura de; Souza, Mariana Fernandes Cremasco de; Whitaker, Iveth Yamaguchi. Risco para lesão por pressão em pacientes de unidade de terapia intensiva. Revista Cuidarte. 2021;12(2):e1196. http://dx.doi.org/10.15649/cuidarte.1196
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Aghazadeh A, Lotfi M, Asgarpour H, Khajehgoodari M, Nobakht A. Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences. Nurs Open 2021; 8:808-814. [PMID: 33570276 PMCID: PMC7877138 DOI: 10.1002/nop2.685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Abstract
AIM Pressure injuries are considered a common and costly problem in the care of patients. Prevention and identification of risk factors for pressure injuries are very important due to the high cost of treatment and the adverse consequences of pressure injuries. This study aimed to assess the prevalence of pressure injuries and its risk factors in clinical settings of affiliated to Tabriz University of Medical Sciences. DESIGN A descriptive-analytical study. METHODS This study was performed on 200 patients who were selected by random sampling. The data collection tool was a 3-part questionnaire. Data were analysed using a t test, chi-square, Fisher's exact test and logistic regression in SPSS v. 24. RESULTS The mean age of the participants was 51.93 (SD 14.99) years. The rate of pressure injuries in this study was 19.5%. The most susceptible area for pressure injuries were sacral (35.89%) and gluteal (20.51%), respectively. The pressure injuries was significantly associated with Braden's criteria, age, disease diagnosis and length of hospital stay (p < .05). But there was no statistically significant difference between sex and incidence of pressure injuries (p > .05).
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Affiliation(s)
- AhmadMirza Aghazadeh
- Department of Basic SciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Hossein Asgarpour
- Department of Surgical NursingFaculty of Health SciencesÇanakkale Onsekiz Mart UniversityCanakkaleTurkey
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Afsaneh Nobakht
- Faculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
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Bai DL, Liu TW, Chou HL, Hsu YL. Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. PLoS One 2020; 15:e0241276. [PMID: 33166300 PMCID: PMC7652312 DOI: 10.1371/journal.pone.0241276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the development of pressure injuries. METHODS This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients' assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model. RESULTS The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041). CONCLUSIONS A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.
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Affiliation(s)
- Dorothy Li Bai
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
| | - Tsai-Wen Liu
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yeh-Liang Hsu
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
- Mechanical Engineering Department, Yuan Ze University, Taoyuan, Taiwan
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Yu Y, Shen J, Fang G, Wang L, Lei S, Cai D, Shi Y, Jin S, Lu Q, Wang S, Sun Y, Yao J, Hu P, Wu X, He X. Use of autologous platelet rich fibrin-based bioactive membrane in pressure ulcer healing in rats. J Wound Care 2019; 28:S23-S30. [PMID: 30975063 DOI: 10.12968/jowc.2019.28.sup4.s23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To verify the feasibility of treating pressure ulcers (PUs) with autologous platelet-rich fibrin-based (PRF) bioactive membrane, both in vitro and in vivo. METHOD An animal model using adult male Sprague-Dawley rats was used. Pressure was periodically exerted on the skin to induce localised ischaemia by using an external magnet and transplanted metal disc. After a PU developed, the rats were divided into two groups: a treatment group and a control group. Rats in the treatment group were then treated with PRF bioactive membrane every three days. RESULTS A total of 20 rats were used in this study. At days three and seven, the PU area in the PRF bioactive membrane-treated group was significantly smaller than that in the control group, and after 14 days of treatment, the PUs in the PRF bioactive membrane treatment group had healed. Haemotoxylin and eosin staining, immunohistochemistry and Western blot results indicated that PRF bioactive membrane induced wound healing by increasing the thickness of the regenerated epidermis and by upregulating vascular endothelial growth factor expression. Further, we found that different concentrations of rat autologous PRF soluble factors extraction components could significantly promote rat aortic endothelial cell proliferation, wound healing and migration ability in vitro. CONCLUSION Overall, results indicate that PRF bioactive membrane promotes PU healing in rats. Thus, it may represent a natural and effective wound-healing tool for use in the treatment of clinical skin PUs in humans in the future.
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Affiliation(s)
- Yajuan Yu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jian Shen
- Technologist-in-charge, Department of Blood Transfusion, Zhejiang Provincial People's Hospital; People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Guizhen Fang
- Lead Nurse Advanced Nurse Practitioner, Nursing Department of Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Lingcong Wang
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shu Lei
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Danli Cai
- Associate Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Ying Shi
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shuifang Jin
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Qiaoli Lu
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Sisi Wang
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Yunlei Sun
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jinmei Yao
- Associate Senior Technician, Department of Laboratory Medicine, Key Laboratory of Clinical In vitro Diagnostic Techniques of Zhejiang Province First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Peiya Hu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Xiaofei Wu
- Senior Nurse; Department of Central Vein Maintenance Center, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hubin Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xujun He
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
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González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs 2017; 27:1028-1037. [DOI: 10.1111/jocn.14091] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- María Isabel González-Méndez
- UGC de Cuidados Intensivos; Hospital Virgen del Rocío; Seville Spain
- Departamento de Enfermería; Universidad de Sevilla; Sevilla España
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