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Jin F, Fu YJ, Zhang Y, Yan JL, Zhou KC, Liu HW. Effect of intraoperative pressure ulcer preventive nursing on inflammatory markers in patients with high-risk pressure ulcers: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20254. [PMID: 32443363 PMCID: PMC7254853 DOI: 10.1097/md.0000000000020254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will be designed to appraise the effects of intraoperative pressure ulcer preventive nursing (IPUPN) on inflammatory markers (IMs) in patients with high-risk pressure ulcers (HRPU) based on high quality randomized controlled trials (RCTs). METHODS In this study, we will perform a rigorous literature search from the following electronic databases: Cochrane Library, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. All electronic databases will be retrieved from their initial time to March 1, 2020 without limitations of language and publication status. We will only consider high quality RCTs that explored the effects of IPUPN on IMs in patients with HRPU. Two investigators will identify relevant trials, extract data, and appraise risk of bias in each eligible trial. Data will be pooled by either a fixed-effects model or a random-effects model according to the results of heterogeneity identification. The primary outcomes include IMs, and incidence of new pressure ulcers. The secondary outcomes are time to ulcer development, quality of life, length of hospital stay, and adverse events. Statistical analysis will be undertaken using RevMan 5.3 software. RESULTS This study will summarize high quality clinical evidence of RCTs to evaluate the effects of IPUPN on IMs in patients with HRPU. CONCLUSION The expected findings may provide helpful evidence to determine whether IPUPN is an effective intervention on IMs in patients with HRPU. INPLASY REGISTRATION NUMBER INPLASY202040029.
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Affiliation(s)
| | | | | | | | | | - Hong-wei Liu
- Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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2
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A Matrix Metalloproteinase Sensing Biosensor for the Evaluation of Chronic Wounds. BIOCHIP JOURNAL 2019. [DOI: 10.1007/s13206-019-3403-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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3
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Loss SH, Nunes DSL, Franzosi OS, Salazar GS, Teixeira C, Vieira SRR. Chronic critical illness: are we saving patients or creating victims? Rev Bras Ter Intensiva 2018; 29:87-95. [PMID: 28444077 PMCID: PMC5385990 DOI: 10.5935/0103-507x.20170013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022] Open
Abstract
The technological advancements that allow support for organ dysfunction have led
to an increase in survival rates for the most critically ill patients. Some of
these patients survive the initial acute critical condition but continue to
suffer from organ dysfunction and remain in an inflammatory state for long
periods of time. This group of critically ill patients has been described since
the 1980s and has had different diagnostic criteria over the years. These
patients are known to have lengthy hospital stays, undergo significant
alterations in muscle and bone metabolism, show immunodeficiency, consume
substantial health resources, have reduced functional and cognitive capacity
after discharge, create a sizable workload for caregivers, and present high
long-term mortality rates. The aim of this review is to report on the most
current evidence in terms of the definition, pathophysiology, clinical
manifestations, treatment, and prognosis of persistent critical illness.
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Affiliation(s)
- Sergio Henrique Loss
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | - Diego Silva Leite Nunes
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Oellen Stuani Franzosi
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Departamento de Nutrição, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Cassiano Teixeira
- Faculdade de Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil.,Departamento de Clínica Médica, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Mehaffey JH, Politano AD, Bhamidipati CM, Tracci MC, Cherry KJ, Kern JA, Kron IL, Upchurch GR. Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization. Surgery 2017; 161:1720-1727. [PMID: 28318554 DOI: 10.1016/j.surg.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. METHODS Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non-decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. RESULTS A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non-decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non-decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non-decubitus ulcer cohort (non-decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). CONCLUSION Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Amani D Politano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | | | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Kenneth J Cherry
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - John A Kern
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Irving L Kron
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
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5
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Saidkhani V, Asadizaker M, Khodayar MJ, Latifi SM. The effect of nitric oxide releasing cream on healing pressure ulcers. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:322-30. [PMID: 27186212 PMCID: PMC4857669 DOI: 10.4103/1735-9066.180389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/04/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pressure ulcer is one of the main concerns of nurses in medical centers around the world, which, if untreated, causes irreparable problems for patients. In recent years, nitric oxide (NO) has been proposed as an effective method for wound healing. This study was conducted to determine the effect of nitric oxide on pressure ulcer healing. MATERIALS AND METHODS In this clinical trial, 58 patients with pressure ulcer at hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were homogenized and later divided randomly into two groups of treatment (nitric oxide cream; n = 29) and control (placebo cream; n = 29). In this research, the data collection tool was the Pressure Ulcer Scale for Healing (PUSH). At the outset of the study (before using the cream), the patients' ulcers were examined weekly in terms of size, amount of exudates, and tissue type using the PUSH tool for 3 weeks. By integrating these three factors, wound healing was determined. Data were analyzed using SPSS. RESULTS Although no significant difference was found in terms of the mean of score size, the amount of exudates, and the tissue type between the two groups, the mean of total score (healing) between the two groups was statistically significant (P = 0.04). CONCLUSIONS Nitric oxide cream seems to accelerate wound healing. Therefore, considering its easy availability and cost-effectiveness, it can be used for treating pressure ulcers in the future.
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Affiliation(s)
- Vahid Saidkhani
- School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Chronic Disease Care Research Center, Ahvaz, Iran
| | - Marziyeh Asadizaker
- Department of Medical Surgical, Chronic Disease Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Sayed Mahmoud Latifi
- Department of Biostatistics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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6
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Loss SH, de Oliveira RP, Maccari JG, Savi A, Boniatti MM, Hetzel MP, Dallegrave DM, Balzano PDC, Oliveira ES, Höher JA, Torelly AP, Teixeira C. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva 2015; 27:26-35. [PMID: 25909310 PMCID: PMC4396894 DOI: 10.5935/0103-507x.20150006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/20/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). METHODS This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. RESULTS There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. CONCLUSION The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.
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Affiliation(s)
- Sérgio Henrique Loss
- Departamento de Terapia Intensiva, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
| | | | | | - Augusto Savi
- Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Márcio Pereira Hetzel
- Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
| | - Daniele Munaretto Dallegrave
- Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
| | | | | | - Jorge Amilton Höher
- Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
| | - André Peretti Torelly
- Departamento de Terapia Intensiva, Unidade de Terapia Intensiva Santa Rita, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
| | - Cassiano Teixeira
- Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
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7
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Peart J, Richardson A. Developing a critical care bowel management assessment tool to manage faecal incontinence. Nurs Crit Care 2014; 20:34-40. [PMID: 25270763 DOI: 10.1111/nicc.12101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/01/2014] [Accepted: 04/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Critical care patients with faecal incontinence are at high risk of developing moisture lesions, pressure ulcers and secondary infection. AIMS The aims of this quality improvement programme were to identify the level of harm caused by faecal incontinence in critical care, and to review current critical care nursing practice on the use of bowel management systems, with the intent to implement changes to prevent delayed insertion. THE IMPROVEMENT PROGRAMME A four-step approach was used to guide the improvement programme. A total of seven case studies across three critical care units were reviewed and information was collected on stool type and frequency, duration of diarrhoea and skin integrity prior to bowel management system insertion. DISCUSSION Critical care nurses may not always use a consistent approach to the assessment of patients at risk of moisture or pressure damage due to faecal incontinence. Lack of knowledge about the maintenance of bowel management systems was viewed as a likely reason for the inconsistent approach. A Critical Care Bowel Management Assessment Tool was created, to contribute towards a more standardised approach to bowel assessment and management. CONCLUSIONS Inadequate assessment and management of faecal incontinence may have implications for critically ill patients. Further evaluation is required in order to demonstrate over time whether the changes made, as a result of this quality improvement programme, have led to sustainable improvement.
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Affiliation(s)
- Joanna Peart
- Newcastle Hospitals, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
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8
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Mehmood M, Jaffar NA, Nazim M, Khasawneh FA. Bacteremic skin and soft tissue infection caused by Prevotella loescheii. BMC Infect Dis 2014; 14:162. [PMID: 24661318 PMCID: PMC3997918 DOI: 10.1186/1471-2334-14-162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Anaerobes are a major component of gut flora. They play an important role in the pathogenesis of infections resulting from breaches in mucus membranes. Because of the difficulties in cultivating and identifying it, their role continues to be undermined. The purpose of this paper is to report a case of Prevotella loescheii bacteremic skin and soft tissue infection and review the literature. Case presentation A 42-year-old Caucasian man was admitted for an elective bariatric surgery. A lengthy intensive care unit stay and buttocks decubitus ulcers complicated his post-operative course. After being transferred to a long-term care facility, the decubitus ulcer became secondarily infected with multiple bacteria including P. loescheii; an anaerobe that grew in blood and wound cultures. The patient was treated successfully with aggressive surgical debridement, antibiotics and subsequent wound care. Conclusion P. loescheii colonizes the gut and plays an important role in periodontal infections. In rare occasions and under suitable circumstances, it can infect skin and soft tissues as well as joints. Given the difficulties in isolating anaerobes in the microbiology lab, considering this bacterium alongside other anaerobes in infections of devitalized tissue is indicated even if cultures were reported negative.
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Affiliation(s)
| | | | | | - Faisal A Khasawneh
- Section of Infectious Diseases, Department of internal medicine, Texas Tech University Health Sciences Center, 1400 S, Coulter Street, Amarillo, TX 79106, USA.
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9
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Loss SH, Marchese CB, Boniatti MM, Wawrzeniak IC, Oliveira RP, Nunes LN, Victorino JA. Prediction of chronic critical illness in a general intensive care unit. Rev Assoc Med Bras (1992) 2013; 59:241-7. [PMID: 23680275 DOI: 10.1016/j.ramb.2012.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score <15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model. CONCLUSIONS CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.
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Affiliation(s)
- Sérgio H Loss
- Department of Critical Care Medicine, Hospital de Clínicas, Porto Alegre, RS, Brazil.
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10
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O'Neill DK, Robins B, Ayello EA, Cuff G, Linton P, Brem H. Regional anaesthesia with sedation protocol to safely debride sacral pressure ulcers. Int Wound J 2012; 9:525-43. [PMID: 22520149 PMCID: PMC7950615 DOI: 10.1111/j.1742-481x.2011.00912.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A treatment challenge for patients with sacral pressure ulcers is balancing the need for adequate surgical debridement with appropriate anaesthesia management. We are functioning under the hypothesis that regional anaesthesia has advantages over general anaesthesia. We describe our regional anaesthesia protocol for perioperative and postoperative management.
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Affiliation(s)
- Daniel K O'Neill
- Department of Anesthesiology, New York University School of Medicine, New York, NY 10016, USA.
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11
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Abstract
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Commonwealth Medical College Scranton, PA 18510, USA
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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12
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Abstract
Heel ulcers are clinically challenging. Limited subcutaneous tissue covering the calcaneus bone makes the heel vulnerable to pressure injury. Adequate debridement of fibrotic, infected, and necrotic tissue is essential for healing. The authors report a standardized anesthesia protocol using regional anesthesia with sedation rather than general anesthesia for heel debridement.
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13
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Esperón Güimil JA, Freire Rodríguez M, Escudero Quiñones AI, Ocampo Piñeiro A, Pernas Silva CT, González González M, Rodríguez Sánchez MA, Poceiro Salgado SM, Sánchez Ayala T, Vázquez Patiño MB. [Endonasal tubes as cause of pressure ulcers in the critical patient]. ENFERMERIA INTENSIVA 2009; 20:10-8. [PMID: 19401088 DOI: 10.1016/s1130-2399(09)70662-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION One of the risks of using endonasal tubes (ET) is the appearance of pressure ulcers (PU). OBJECTIVE To ascertain the proportion of patients with nasal PU, study the risk factors of appearance, and find predictive variables. MATERIAL AND METHODS A six-month prospective, observational study of intensive care unit patients with ET. VARIABLES Variable response: "the appearance of pu as a result of the use of ET". Explanatory variables: age, duration of stay, length of time with ET, gender, sedation, norepinephrine perfusion, mechanical ventilation, anemia, nutritional state. ANALYSIS multivariate statistical techniques (multiple logistical regression). Statistics program g-stat 2.0. Significance level p < 0.05. RESULTS Sample of 48 patients. Proportion of patients with PU: 29.2%. Those patients with PU had similar ages, duration of stay and longer length of time with ET. Results of the Logistic Regression model: only the variable "time with ET" was statistically significant (p = 0.03; odds ratio: 1.047). CONCLUSIONS The length of time the patient is using an ET influences the appearance of nasal PU (risk increases 1.047 for each day with ET). None of the variables dealt with could be used as a predictive factor in the appearance of PU.
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Affiliation(s)
- J A Esperón Güimil
- Unidad de Cuidados Intensivos, Hospital Montecelo, Complejo Hospitalario de Pontevedra, Pontevedra, España.
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14
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Abstract
Critical illness can be viewed as consisting of 4 distinct stages: (1) acute critical illness (ACI), (2) prolonged acute critical illness, (3) chronic critical illness, and (4) recovery. ACI represents the evolutionarily programmed response to a stressor. In ACI, substrate is shunted away from anabolism and toward vital organ support and inflammatory proteins. Nutrition support in this stage is unproven and may ultimately prove detrimental. As critical illness progresses, there is no evolutionary precedent, and man owes his life to modern critical care medicine. It is at this point that nutrition and metabolic support become integral to the care of the patient. This paper (1) delineates and develops the 4 stages of critical illness using current evidence, clinical experience, and new hypotheses; (2) defines the chronic critical illness syndrome (CCIS); and (3) details an approach to the metabolic and nutrition support of the chronically critically ill patient using the metabolic model of critical illness as a guide. It is our hope that this clinical model can generate testable hypotheses that can improve the outcome of this unique population of patients.
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Affiliation(s)
- Jason M Hollander
- Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai of Medicine, New York, NY 10128, USA.
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15
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Scheinhorn DJ, Hassenpflug MS, Votto JJ, Chao DC, Epstein SK, Doig GS, Knight EB, Petrak RA. Ventilator-Dependent Survivors of Catastrophic Illness Transferred to 23 Long-term Care Hospitals for Weaning From Prolonged Mechanical Ventilation. Chest 2007; 131:76-84. [PMID: 17218559 DOI: 10.1378/chest.06-1079] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) for weaning from mechanical ventilation. DESIGN Observational study with concurrent data collection. Characteristics of the LTCHs were also surveyed. SETTING Twenty-three LTCHs in the United States. PATIENTS Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003. RESULTS A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of the patients was 71.8 years old (range, 18 to 97.7 years), with an equal gender distribution. The premorbid domicile was home or assisted living in 86.5%; "good" premorbid functional status (Zubrod score 0-2) was assessed in 77%. There was a history of smoking in 59% (mean, 57 +/- 42 pack-years [+/- SD]); premorbid diagnoses averaged 2.6 per patient. Patients came to the LTCH after mean of 33.8 +/- 29 days at the transferring hospital; mean time to tracheotomy was 15.0 +/- 10 days. A medical illness led to ventilator dependency in 60.8% of patients; a surgical procedure led to ventilatory dependency in 39.2%. On admission to the LTCH, the median acute physiology score of APACHE (acute physiology and chronic health evaluation) III was 35 (range, 4 to 115); > 90% of patients had at least three penetrating indwelling tubes/catheters; 42% of patients had stage 2 or higher pressure ulceration. CONCLUSIONS This is the first multicenter study to characterize ventilator-dependent survivors of catastrophic illness admitted to the post-ICU venue of LTCHs for weaning from prolonged mechanical ventilation (PMV). Overall, our findings suggest that ventilator-dependent patients admitted to LTCHs for weaning will continue to require considerable medical interventions and treatments, owing to the burden of acute-on-chronic diseases resulting in PMV.
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Affiliation(s)
- David J Scheinhorn
- Barlow Respiratory Hospital and Research Center, 2000 Stadium Way, Los Angeles, CA 90026, USA
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16
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Abstract
OBJECTIVE To identify what has been published in the literature about acute and chronic skin failure and to propose a working definition of this phenomenon. DESIGN A systematic review of MEDLINE and CINAHL to determine what has been published in the literature on the topics of skin failure, acute skin failure, chronic skin failure, multiple organ failure, end-of-life skin deterioration, and pressure ulcers in hospice from 1984 to 2005. MAIN OUTCOME MEASURES Published papers were reviewed for content related to acute, chronic, and end-stage skin failure. MAIN RESULTS Seven articles were identified that referenced either acute, chronic, or end-stage skin failure. Additional information was identified that discussed the processes of acute and chronic skin failure and pressure ulcers in individuals in hospice care or at the end of life. Care considerations and dilemmas related to a curative versus palliative goal in wound healing were discussed. CONCLUSIONS Minimal literature exists on skin failure, yet caregivers and the public must be aware of, assess for, and consider this phenomenon in their care. Based on this literature review, skin failure was defined by the authors as an event in which the skin and underlying tissue die due to hypoperfusion that occurs concurrent with severe dysfunction or failure of other organ systems. Skin failure can be categorized as acute, chronic, or end stage. Pressure ulcers, a type of skin death, frequently occur in persons with a heavy disease burden, especially those at or near the end of life, despite good care.
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Affiliation(s)
- Diane K Langemo
- University of North Dakota College of Nursing, Grand Forks, ND, USA
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17
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Abstract
PURPOSE To provide the physician and registered professional nurse with an understanding of consistent wound documentation and the potential for legal issues to arise. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in better understanding and improving policies and procedures related to wound documentation. OBJECTIVES After reading the article and taking the test, the participant should be able to: 1. Discuss wound assessment and documentation relative to current practices and potential legal implications. 2. Describe recommendations to improve the consistency and accuracy of wound assessment and documentation.
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18
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Abstract
Assessing skin is a simple method of reducing pressure ulcer occurrence and is easily accomplished by both trained and untrained staff. The important issue, once the risk has been identified, is to supply equipment in the shortest time possible. A new mattress, SimCair, developed by Hill-Rom Ltd, is designed for just such a reason. It is a lightweight overlay that combines air and viscoelastic foam in order to redistribute the body weight and thus reduce risk. SimCair is easily transported and can be ready for instant and automatic inflation as soon as it is required. It is also durable and simple to clean between patients. A small evaluation was undertaken in one nursing home to assess the benefits to the residents.
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Roth RS, Lowery JC, Hamill JB. Assessing persistent pain and its relation to affective distress, depressive symptoms, and pain catastrophizing in patients with chronic wounds: a pilot study. Am J Phys Med Rehabil 2004; 83:827-34. [PMID: 15502735 DOI: 10.1097/01.phm.0000140800.83146.fa] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to examine pain experience among patients with chronic wounds, assess the utility of pain assessment scales for chronic wound-related pain, and determine the relation of wound-related pain to wound stage, affective distress, depressive symptoms, and pain catastrophizing. DESIGN In this cross-sectional study of patients with a mix of chronic wounds (n = 69) recruited for a study evaluating a telemedicine system for assessing chronic wounds, 19 men (12 with spinal cord injury) with wound-related pain were identified. Questionnaires included the Numerical Pain Rating Scale, McGill Pain Questionnaire, Brief Symptom Inventory, Center for Epidemiologic Studies Depression Scale, and the catastrophizing scale of the Coping Strategies Questionnaire. RESULTS The McGill Pain Questionnaire was more sensitive to pain experience than a single rating of pain intensity. Wound stage was positively related to severity of pain. Pain catastrophizing was positively related to pain intensity and higher levels of affective distress and depressive symptoms. CONCLUSIONS Pain associated with chronic wounds is a significant clinical challenge for both patients and health practitioners.
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Affiliation(s)
- Randy S Roth
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan 48109-0718, USA
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20
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Abstract
Bed-bound patients with pressure ulcers are almost twice as likely to die as are those without pressure ulcers. If pressure ulcers are treated with a comprehensive regimen upon early recognition, nearly all stage IV ulcers can be avoided. Furthermore, such a regimen can significantly reduce the comorbidities, mortalities, and costs of treatments resulting from stage IV ulcers. The costs of treatments for comorbidities after the ulcer progresses to stage IV far outweigh the costs for early treatment of the ulcer before it progresses beyond the early stages. We describe herein the 4 stages of pressure ulcers, as well as the pathogeneses, costs, and complications associated with these wounds. A comprehensive 12-step detailed protocol for treatment of pressure ulcers is described; this includes recognizing that every patient with limited mobility is at risk for developing a sacral, ischial, trochanteric, or heel ulcer; daily assessment of the skin; objective measurement of every wound; immediate initiation of a treatment protocol; mechanical debridement of all nonviable tissue; establishment of a moist wound-healing environment; nutritional supplementation for malnourished patients; pressure relief for the wound; elimination of drainage and cellulitus; biological therapy for patients whose wounds fail to respond to more traditional therapies; physical therapy; and palliative care. Availability of the described treatment modalities, in combination with early recognition and regular monitoring, ensures rapid healing and minimizes morbidity, mortality, and costs.
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Affiliation(s)
- Harold Brem
- Department of Surgery, Columbia University College of Physicians & Surgeons, 5141 Broadway, New York, New York 10034, USA.
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21
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El-Solh AA. Clinical approach to the critically ill, morbidly obese patient. Am J Respir Crit Care Med 2004; 169:557-61. [PMID: 14982823 DOI: 10.1164/rccm.200309-1256cc] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ali A El-Solh
- Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, New York, USA.
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Weston C, Hampton S. TheraPulse ATP for preventing and treating pressure ulcers. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2003; 12:S42-6. [PMID: 12937384 DOI: 10.12968/bjon.2003.12.sup3.11435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
In the modern healthcare environment where evidence-based best practice is key in seeking quality improvements for patient care, using treatment and therapies that have evidence of clinical efficacy is paramount. The current evidence bases supporting pulsating air suspension therapy is excellent and the improved lymphatic flow and enhanced microcirculation along with reduction of pressure ulcer potential (El-Habbal and Smith, 1996; Gunther and Brofeldt, 1996) ensures a firm place for TheraPulse ATP (KCI Medical) in reduction of oedema and pressure ulcers in the critically ill patient.
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Hampton S. The QUATTRO ACUTE mattress and pressure ulcer prevention. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2003; 12:697-8, 700-1. [PMID: 12829970 DOI: 10.12968/bjon.2003.12.11.11320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are a plethora of mattresses on the market and nurses are not always sure which mattress to select for each individual patient. This article outlines the issues in preventing and understanding pressure ulcers and the performance of the QUATTRO ACUTE trade mark mattress, manufactured by Talley Medical.
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