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Bates-Jensen BM, Crocker J, Nguyen V, Robertson L, Nourmand D, Chirila E, Laayouni M, Offendel O, Peng K, Romero SA, Fulgentes G, McCreath HE. Decreasing Intraoperative Skin Damage in Prone-Position Surgeries. Adv Skin Wound Care 2024; 37:413-421. [PMID: 39037095 DOI: 10.1097/asw.0000000000000186] [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: 07/23/2024]
Abstract
OBJECTIVE To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery. METHODS In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data. RESULTS Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants. CONCLUSIONS Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.
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Affiliation(s)
- Barbara M Bates-Jensen
- At the University of California, Los Angeles (UCLA), Los Angeles, California, US, Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, Los Angeles School of Nursing and David Geffen School of Medicine; Jessica Crocker, BA, is Project Director, Division of Geriatrics, David Geffen School of Medicine; and Vicky Nguyen, MSN, is Graduate Student, School of Nursing. Lauren Robertson, BS, is Senior Quality Control Analytical Associate, ImmunityBio, Los Angeles, California. Deborah Nourmand, MSN, RN, is Registered Nurse, UCLA Santa Monica Surgery Center, Santa Monica, CA. At the School of Nursing, UCLA, Emily Chirila, BSN, is Nursing Student; Mohamed Laayouni, MSN, is Nursing Student; Ofelia Offendel, MSN, is Student Nurse; Kelly Peng, BA, is Graduate Student Research Assistant; and Stephanie Anne Romero, MSN, is Graduate Student Researcher. Gerry Fulgentes, MSN, RN, CWOCN, PCCN, is Clinical Manager, Wounds, Ostomy, and Continence Services, UCLA Santa Monica Medical Center. Heather E. McCreath, PhD, is Adjunct Professor, Division of Geriatrics, David Geffen School of Medicine, UCLA
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Lucchini A, Villa M, Maino C, Alongi F, Fiorica V, Lipani B, Ponzetta G, Vigo V, Rezoagli E, Giani M. The occurrence of pressure injuries and related risk factors in patients undergoing extracorporeal membrane oxygenation for respiratory failure: A retrospective single centre study. Intensive Crit Care Nurs 2024; 82:103654. [PMID: 38387296 DOI: 10.1016/j.iccn.2024.103654] [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: 02/04/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Limited data is available regarding the incidence of pressure injuries in patients who have undergone Extracorporeal Membrane Oxygenation (ECMO), a life-saving technique that provides respiratory support for hypoxemia that does not respond to conventional treatment. AIM To assess the incidence of pressure injuries and identify the risk factors in Acute Respiratory Distress Syndrome patients receiving ECMO. METHODS A retrospective observational study utilizing prospectively collected data was performed in an Italian intensive care unit, between 1 January 2012 and 30 April 2022 enrolling all consecutive patients with Acute Respiratory Distress Syndrome who underwent ECMO. RESULTS One hundred patients were included in this study. 67 patients (67%) developed pressure injuries during their intensive care unit stay, with a median of 2 (1-3) sites affected. The subgroup of patients with pressure injuries was more hypoxic before ECMO implementation, received more frequent continuous renal replacement therapy and prone positioning, and showed prolonged ECMO duration, intensive care unit and hospital length of stay compared to patients without pressure injuries. The logistic model demonstrated an independent association between the pO2/FiO2 ratio prior to ECMO initiation, the utilization of the prone positioning during ECMO, and the occurrence of pressure injuries. CONCLUSIONS The incidence of pressure injuries was elevated in patients with Adult Respiratory Distress Syndrome who received ECMO. The development of pressure injuries was found to be independently associated with hypoxemia before ECMO initiation and the utilization of prone positioning during ECMO. IMPLICATIONS FOR CLINICAL PRACTICE Patients who require ECMO for respiratory failure are at a high risk of developing pressure injuries. To ensure optimal outcomes during ECMO implementation and treatment, it is vital to implement preventive measures and to closely monitor skin health in at-risk areas.
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Affiliation(s)
- Alberto Lucchini
- Direction of Health and Social Professions, General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza - University of Milano-Bicocca, Italy.
| | - Marta Villa
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clara Maino
- Direction of Health and Social Professions, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Francesca Alongi
- Cardiologic Intensive Care Unit, ASST GOM Niguarda, Milano, Italy
| | | | - Barbara Lipani
- General ICU - A.O.U.I. Verona Policlinico G.B. Rossi, Italy
| | - Giuseppe Ponzetta
- Centro Sanitario Bregaglia - Pronto Soccorso, Promontogno, Svizzera, Switzerland.
| | - Veronica Vigo
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Marco Giani
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
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Fourie A, Ahtiala M, Black J, Campos HH, Coyer F, Gefen A, LeBlanc K, Smet S, Vollman K, Walsh Y, Karlberg-Traav M, Beeckman D. Enhancing prone positioning and skin damage prevention education: A randomized controlled non-inferiority trial comparing a digital education hub (PRONEtect) and a traditional lecture on final-year nursing participants' confidence and knowledge. J Tissue Viability 2024; 33:298-304. [PMID: 38402096 DOI: 10.1016/j.jtv.2024.02.008] [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: 09/20/2023] [Revised: 11/27/2023] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The incidence of pressure ulcers remains high in patients with moderate to severe acute respiratory distress syndrome, ventilated in the prone position. A digital platform, dedicated to prone positioning and skin/tissue damage education was developed. OBJECTIVE To evaluate the impact of the PRONEtect Education Hub versus a traditional lecture on final-year nursing students' confidence levels and knowledge in a non-inferiority study. DESIGN A multicenter, non-blinded, parallel-group, non-inferiority study with equal randomization (1:1 allocation) was conducted at two nursing schools in Belgium. CLINICALTRIALS gov (NCT05575869). METHODS Following baseline assessments, the control group received a 1-h classroom lecture, and the experimental group gained access to the PRONEtect website. Three weeks later, participants completed the knowledge, confidence, and visual knowledge assessment. RESULTS At baseline, 67 of the 80 participants completed the assessments and post-intervention, 28 and 27 participants respectively completed the confidence, knowledge, and visual knowledge assessments (dropout rate of 66.25%). Confidence levels: a mean ratio of relative change from baseline = 0.96 (Control (C)/Experimental (E)); 97.5% confidence interval (CI): 0.74 to 1.26; p = 0.74. Knowledge assessment: a mean difference in change from baseline = 1.58 (C-E); 97.5% CI: -0.58 to 3.75; p = 0.1. Although confidence and knowledge scores increased in both groups, the study cannot conclude non-inferiority. CONCLUSIONS The trade-off between the inability to conclude efficacy of the impact of the website and the benefit of having an accessible educational platform on prone positioning and skin damage prevention makes the PRONEtect Education Hub an acceptable adjunct to traditional lecturing.
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Affiliation(s)
- Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Maarit Ahtiala
- Service Division, Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
| | - Joyce Black
- Niedfeft Professor of Nursing, University of Nebraska Medical Center, College of Nursing, Omaha, NE, USA.
| | - Heidi Hevia Campos
- Adult Health Graduation Program, School of Nursing, University of São Paulo, Brazil.
| | - Fiona Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
| | - Amit Gefen
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
| | - Kim LeBlanc
- Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Canada; Affiliate Faculty, Ingram School of Nursing, Faculty of Medicine, McGill University, Canada.
| | - Steven Smet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Wound Care Center, Ghent University Hospital, Ghent, Belgium.
| | - Kathleen Vollman
- Advancing Nursing LLC, Adjunct Faculty Michigan State University, Northville, MI, USA.
| | - Yolanda Walsh
- YL Walsh (Pty) Ltd, Adjunct Lecturer Stellenbosch University, Western Cape, South Africa.
| | - Malin Karlberg-Traav
- Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden.
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Xu X, Miao M, Shi G, Zhang P, Liu P, Zhao B, Jiang L. Operative Positioning and Intraoperative-Acquired Pressure Injury: A Retrospective Cohort Study. Adv Skin Wound Care 2024; 37:148-154. [PMID: 38393704 DOI: 10.1097/asw.0000000000000108] [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: 02/25/2024]
Abstract
OBJECTIVE To comprehensively assess the association between operative positioning with intraoperative-acquired pressure injury (IAPI) development. METHODS This retrospective cohort study included 455 patients who underwent surgery between October 2020 and January 2021. The authors grouped patients by operative positioning into the prone position and nonprone position groups. They used propensity-score matching at a 1:2 ratio to control for preoperative confounders, applied multiple logistic regression models to analyze the effects between positioning and IAPI, and assessed interactions of positioning and intraoperative factors on IAPI. RESULTS The final enrollment was 92 cases in the prone position group and 181 in the nonprone position group. Multivariable logistic analysis suggested that the prone position had a 2.92 times higher risk of IAPI than the nonprone position (odds ratio, 2.92; 95% CI, 1.13-7.57; P = .026). Subgroup analysis showed a significant multiplicative interaction between positioning and foam dressing on IAPI (P < .05), which was not observed in other intraoperative factors (P > .05). CONCLUSIONS This study provides evidence that prone operative positioning can increase IAPI risk. Patients in the prone position may particularly benefit from using dressings in Chinese populations. Further large-sample longitudinal studies are required to confirm these findings.
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Affiliation(s)
- Xin Xu
- At the Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China, Xin Xu, MSN, is Clinical Nurse. Miao Miao, MSN, is Graduate, Shanghai Jiaotong University. Also at Xinhua Hospital, Guirong Shi, MSN, is Clinic Nurse; Peipei Zhang, BS, is Nursing Supervisor of the Emergency Operating Room; Ping Liu, MSN, is Associate Director of the Nursing Department RN; Bing Zhao, MSN, is Anesthetist Nurse; and Liping Jiang, PhD, is Professor and Chief Nursing Officer. Acknowledgments: The authors thank Chengnan Guo from the School of Public Health, Fudan University, Shanghai, China, who provided statistical guidance and support for this 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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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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Liu X, Wang Y, Lin L, Wang L, Li M, Zhang L, Zhou H, Xu X. Precise Nursing of Six Patients Who Underwent Second Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Proc 2023; 55:1726-1730. [PMID: 37393171 DOI: 10.1016/j.transproceed.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
This study aimed to summarize the experience of precise nursing in 6 patients who experienced failed allogeneic hematopoietic stem cell transplantations (allo-HSCTs) that underwent second allo-HSCT salvage treatment. The key points of nursing care included strictly implementing infection prevention and control measures to prevent secondary infections, precise symptom management to improve the graft survival rate of patients, formulating reasonable nutrition programs to meet their requirements, and paying attention to the psychological care of patients to enhance their self-confidence in overcoming diseases. The patients developed different degrees of complications in the process of transplantation. During the transplantation, 2 patients had oral mucositis, 2 had hemorrhagic cystitis, 3 had a perianal infection, and one had lower gastrointestinal bleeding. After careful treatment and nursing, the neutrophils transplanted in the 6 patients were alive at a median of 16.5 (13-20) days after the second allo-HSCT, and the patients were successfully transferred out of the laminar flow chamber.
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Affiliation(s)
- Xiaolin Liu
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Yu Wang
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Le Lin
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Lei Wang
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Meijia Li
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Le Zhang
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Haiying Zhou
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Xiaodong Xu
- Department of Hematology, Peking University People's Hospital, Beijing, China.
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Wang Z, Fan J, Chen L, Xie L, Huang L, Ruan Y, Xu X, Liang Z. Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study. Front Med (Lausanne) 2023; 10:1131270. [PMID: 37644983 PMCID: PMC10461099 DOI: 10.3389/fmed.2023.1131270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. Propose To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. Methods The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. Results After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. Conclusion According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.
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Affiliation(s)
- Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Jiangshan Fan
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Lingfang Huang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Yang Ruan
- Department of Outpatient, The 79th Hospital of Group Army, Liaoning, China
| | - Xia Xu
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Zeping Liang
- Department of Nursing, Daping Hospital, Chongqing, China
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Otto P, Großkreutz T, Köberich S. Silicone adhesive multilayer foam dressings for preventing facial pressure injuries in COVID-19 patients in prone position. J Intensive Care Soc 2023; 24:332-334. [PMID: 37744080 PMCID: PMC8886309 DOI: 10.1177/17511437221079122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The development of facial pressure injury (PI) during prone position is frequently described. During the COVID-19 pandemic, the number of patients with facial PIs increased. This quality improvement project describes the effectiveness of using silicone adhesive multilayer foams for preventing facial PIs in COVID-19 patients in need of prone position therapy. After introduction of foam dressing on chin and forehead to the standard protocol procedures for PI prevention, the decrease in number of patients developing facial PIs was statistically significant. Based on these results, the use of silicone adhesive multilayer foam will be implemented as a standard procedure for facial PIs prevention.
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Affiliation(s)
- Pia Otto
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tobias Großkreutz
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Stefan Köberich
- Nursing Direction, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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DeMellow JM, Dhillon H, Bhattacharyya M, Pacitto D, Kozik TM. Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:197-202. [PMID: 37146109 DOI: 10.1097/won.0000000000000976] [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: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the incidence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) and placed in a prone position manually or using a specialty bed designed to facilitate prone positioning. A secondary aim was to compare mortality rates between these groups. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised 160 patients with ARDS managed by prone positioning. Their mean age was 61.08 years (SD = 12.73); 58% (n = 96) were male. The study setting was a 355-bed community hospital in the Western United States (Stockton, California). Data were collected from July 2019 to January 2021. METHODS Data from electronic medical records were retrospectively searched for the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the presence of a COVID-19 infection. RESULTS A majority of patients with ARDS were manually placed in a prone position (n = 106; 64.2%), and 54 of these patients (50.1%) were placed using a specialty care bed. Slightly more than half (n = 81; 50.1%) developed HAPIs. Chi-square analyses showed no association with the incidence of HAPIs using manual prone positioning versus the specialty bed (P = .9567). Analysis found no difference in HAPI occurrences between those with COVID-19 and patients without a coronavirus infection (P = .8462). Deep-tissue pressure injuries were the most common type of pressure injury. More patients (n = 85; 80.19%) who were manually placed in a prone position died compared to 58.18% of patients (n = 32) positioned using the specialty bed (P = .003). CONCLUSIONS No differences in HAPI rates were found when placing patients manually in a prone position versus positioning using a specialty bed designed for this purpose.
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Affiliation(s)
- Jacqueline M DeMellow
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Harbir Dhillon
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Mouchumi Bhattacharyya
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Daniel Pacitto
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Teri M Kozik
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
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Ruhland J, Dähnert E, Zilezinski M, Hauss A. Pressure Injury Prevention in Patients in Prone Position With Acute Respiratory Distress Syndrome and COVID-19. Crit Care Nurse 2023; 43:46-54. [PMID: 37001876 DOI: 10.4037/ccn2023559] [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: 04/03/2023]
Abstract
Introduction
In patients with acute respiratory distress syndrome, prone positioning improves oxygenation and reduces mortality. Pressure injuries occur frequently because of prolonged prone positioning in high-risk patients, and preventive measures are limited. This article describes 2 patients who developed minimal pressure injuries despite several prone positionings. Prevention strategies are also described.
Clinical Findings
A 64-year-old man and a 76-year-old woman were admitted to the hospital with respiratory insufficiency. Due to acute respiratory distress syndrome, both patients were intubated and received mechanical ventilation and prone positioning.
Diagnosis
Both patients had positive test results for SARS-CoV-2 and a diagnosis of acute respiratory distress syndrome.
Interventions
Patient 1 was in prone position for 137 hours during 9 rounds of prone positioning; patient 2, for 99 hours during 6 rounds of prone positioning. The standardized pressure injury prevention bundle for prone positioning consisted of skin care, nipple protection with a multilayer foam dressing, a 2-part prone positioning set, and micropositioning maneuvers. For both patients, 2-cm-thick mixed-porosity polyurethane foam was added between skin and positioning set in the thoracic and pelvic areas and a polyurethane foam cushion was added under the head.
Outcomes
Patient 1 developed no pressure injuries. Patient 2 developed category 2 pressure injuries on the chin and above the right eye during deviations from the protocol.
Conclusion
For both patients, the additional application of polyurethane foam was effective for preventing pressure injuries. These case reports support the addition of polyurethane foam to prevent pressure injuries in patients placed in the prone position.
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Affiliation(s)
- Julia Ruhland
- Julia Ruhland is a registered nurse in a COVID-19 intensive care unit, Department of Nephrology and Medical Intensive Care, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Germany
| | - Enrico Dähnert
- Enrico Dähnert is a registered nurse and practice development manager for nursing, Business Division Nursing Directorate, Nursing Science, Charité, Universitätsmedizin Berlin
| | - Max Zilezinski
- Max Zilezinski is a registered nurse and research associate, Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
| | - Armin Hauss
- Armin Hauss is a registered nurse, research associate, and quality improvement manager, Business Division Nursing Directorate, Nursing Science and Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
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12
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Orlov A, Gefen A. Differences in prophylactic performance across wound dressing types used to protect from device-related pressure ulcers caused by a continuous positive airway pressure mask. Int Wound J 2023; 20:942-960. [PMID: 36106557 PMCID: PMC10031247 DOI: 10.1111/iwj.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Prolonged use of continuous positive airway pressure masks, as often required for non-invasive ventilation, involves a risk for facial tissue breakdown due to the sustained deformations caused by tightening of the stiff mask surfaces to the head and the moist environment. The risk of developing mask-related facial injuries can be reduced through suitable cushioning materials placed at the skin-mask interfaces to spread the localised contact forces and disperse the surface and internal tissue stresses. Using an integrated experimental-computational approach, we compared the biomechanical protective performance of three popular foam-based wound dressings to that of a market-lead hydrocolloid dressing when applied to protect the facial skin under a mask. We measured the compressive stiffness properties of the four commercial dressing types in dry and moist conditions, and then fed those to an anatomically realistic finite element model of an adult male head, with an applied simulated mask. Through this process, we calculated the protective efficacy index of each dressing type, indicating the relative contribution of the specified dressing to alleviating facial soft tissue loads with respect to the no-dressing case. The foam-based dressings generally performed substantially better than the hydrocolloid, but foam dressings were also demonstrated to vary by their protective performance.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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13
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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14
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Kandi LA, Rangel IC, Movtchan NV, Van Spronsen NR, Kruger EA. Comprehensive Management of Pressure Injury. Phys Med Rehabil Clin N Am 2022; 33:773-787. [DOI: 10.1016/j.pmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Facial Pressure Sores in COVID-19 Patients during Prone Positioning: A Case Series and Literature Review. Plast Reconstr Surg Glob Open 2022; 10:e4610. [PMID: 36246073 PMCID: PMC9555603 DOI: 10.1097/gox.0000000000004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has been a source of several stays in intensive care units, increasing the number of prone positioning. In parallel, complications increased, such as facial ulcers. Herein, we present a literature review and a case series about facial pressure sores in COVID-19 patients during prone positioning. This study aimed to show that such facial pressure sores may require surgical intervention in specific cases.
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16
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Dantas AC, Costa ML, Silva ABD, Borges BEC, Araújo JNDM, Vitor AF. Eye Care Interventions in Critical/Surgical Patients in the Prone Position: Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute’s methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: “What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?” The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority.
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17
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Rohée-Traoré A, Kün-Darbois JD, Boucher S. Masseter muscle pressure injury: First report of a prone position complication in patients with COVID-19. Intensive Crit Care Nurs 2022; 71:103251. [PMID: 35396096 PMCID: PMC8940568 DOI: 10.1016/j.iccn.2022.103251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
We report the case of a 59-year-old, obese woman who underwent prolonged prone position during the medical management of an acute respiratory distress syndrome induced by SARS-CoV-2 infection, complicated by a masseter muscle pressure injury. Such side effect may be underestimate in intensive care units and should be prevent by prophylactic dressings on facial weight-bearing sites. The understanding of facial deep tissue injury is essential to guide clinical detection and management of such a complication in COVID-19 patients.
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Affiliation(s)
- Adèle Rohée-Traoré
- Department of Maxillofacial Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France.
| | - Jean-Daniel Kün-Darbois
- Department of Maxillofacial Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France; Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045 ANGERS Cedex 01, France
| | - Sophie Boucher
- Department of ENT and Head and Neck Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France; MitoLab team, MitoVasc Institute, CNRS UMR6015, INSERM U1083, 49933 ANGERS Cedex 09, France
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18
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Alderden J, Kennerly SM, Cox J, Yap TL. Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Adv Crit Care 2022; 33:173-185. [PMID: 35657764 DOI: 10.4037/aacnacc2022335] [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: 11/01/2022]
Abstract
BACKGROUND Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
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Affiliation(s)
- Jenny Alderden
- Jenny Alderden is Associate Professor, Boise State University School of Nursing, 1910 University Dr, Boise, ID 83725
| | - Susan M Kennerly
- Susan M. Kennerly is Professor, East Carolina University College of Nursing, Greenville, North Carolina
| | - Jill Cox
- Jill Cox is Clinical Associate Professor, Rutgers University, and Wound, Ostomy, Continence Advanced Practice Nurse, Englewood Health, Newark, New Jersey
| | - Tracey L Yap
- Tracey L. Yap is Associate Professor, Duke University School of Nursing, Durham, North Carolina
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19
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López M, Fernández-Castro M, Martín-Gil B, Muñoz-Moreno MF, Jiménez JM. Auditing completion of nursing records as an outcome indicator for identifying patients at risk of developing pressure ulcers, falling, and social vulnerability: An observational study. J Nurs Manag 2022; 30:1061-1068. [PMID: 35266605 DOI: 10.1111/jonm.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. BACKGROUND Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. METHOD This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. RESULTS A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. CONCLUSIONS The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. IMPLICATIONS FOR NURSING MANAGEMENT Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.
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Affiliation(s)
- María López
- Nursing Faculty, University de Valladolid, Valladolid, Spain
| | | | - Belén Martín-Gil
- Department of Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María Fe Muñoz-Moreno
- Research Support Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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20
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Lustig M, Gefen A. The biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting prone surgical patients from chest injuries on the operating table. Int Wound J 2022; 19:1786-1796. [PMID: 35243764 PMCID: PMC9615289 DOI: 10.1111/iwj.13783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Pressure ulcers are soft‐tissue damage associated with tissue exposure to sustained deformations and stress concentrations. In patients who are proned for ventilation or surgery, such damage may occur in the superficial chest tissues that are compressed between the rib cage and the support surface. Prophylactic dressings have been previously proven as generally effective for pressure ulcer prevention. In this study, our goal was to develop a novel computational modelling framework to investigate the biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting proned surgical patients from chest pressure ulcers occurring on the operating table, due to body fixation by the Relton‐Hall frame. We compared the levels of mechanical compressive stresses developing in the soft chest tissues, above the sternum and ribs, due to the trunk weight, whilst the body is supported by the Relton‐Hall frame pads, with versus without the prophylactically applied bilateral dressings. The protective efficacy index for the extremely high stresses, above the 95th‐percentile, were 40.5%, 25.6% and 24.2% for skin, adipose and muscle, respectively, indicating that the dressings dispersed elevated soft‐tissue stresses. The current results provide additional support for using soft cellulose fluff core dressings for pressure ulcer prophylaxis, including during surgery.
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Affiliation(s)
- Maayan Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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21
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Ayala K, Redding J, Lynch W, MacKinney T. Brachial plexus injury and facial breakdown as a consequence of proning during COVID-19 treatment. J Am Assoc Nurse Pract 2022; 34:452-456. [PMID: 34636344 DOI: 10.1097/jxx.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT By early 2020, the novel SARS-CoV-2 virus (COVID-19) was spreading rapidly worldwide, and its effects proved devastating. In many critically ill patients afflicted with COVID-19, treatment often involves prolonged periods of proning that, along with other interventions, can lead to improved oxygenation. However, sustaining this position predisposed patients to increased complications. We present a case of an older patient with respiratory failure secondary to COVID-19 who developed rapidly forming facial and knee wounds and a brachial plexus injury from proning. The pressure injuries were unresponsive to standard wound care treatments and resulted in full-thickness wounds. During outpatient posthospital follow-up, a facial eschar was debrided, and weakness of the left shoulder and arm secondary to a brachial plexus injury was identified. This case highlights various complications associated with prolonged proning and the importance of close attention to follow-up by both inpatient and outpatient providers.
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Affiliation(s)
- Kelly Ayala
- Department of Medicine, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jill Redding
- Department of Medicine, Froedtert Hospital, Menominee Falls, Wisconsin
| | - Whitney Lynch
- Department of Medicine, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Theodore MacKinney
- Department of Medicine, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
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22
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Madueño JM, Sayer L. Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S22-S32. [PMID: 35220748 DOI: 10.12968/bjon.2022.31.4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Many patients with COVID-19 admitted to intensive care undergo prone positioning. These patients are at risk of developing facial pressure ulcers (PUs). This study aimed to identify evidence-based recommendations to prevent or reduce their incidence. METHOD A multi-case study was undertaken using secondary data published between November 2020 and April 2021 discussing facial PUs in patients with COVID-19. CINAHL and MEDLINE electronic databases were analysed. Sixteen publications met the inclusion criteria. The overall quality of evidence was low. RESULT Studies reported a high incidence of facial PUs. The evidence suggests key preventive areas are skin assessment, pressure-redistribution surfaces, eye coverings, education, medical devices and prophylactic dressings. Recommendations included skin cleaning and moisturising, eye coverings, replacing endotracheal tube holders and using hydrocolloid or film dressings. CONCLUSION Considering the severe implications for patients and healthcare systems caused by facial PUs, ICUs should develop strategies to prevent and minimise them.
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Affiliation(s)
- Jaime Moreno Madueño
- Registered Nurse, at time of writing studying MSc Nursing with Registration as an Adult Nurse, King's College London
| | - Lynn Sayer
- Senior Lecturer, Department of Adult Nursing, King's College London
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23
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Lustig A, Gefen A. The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests. Int Wound J 2022; 19 Suppl 1:3-21. [PMID: 35142062 PMCID: PMC9478960 DOI: 10.1111/iwj.13761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.
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Affiliation(s)
- Adi Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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24
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Team V, Jones A, Weller CD. Prevention of Hospital-Acquired Pressure Injury in COVID-19 Patients in the Prone Position. Intensive Crit Care Nurs 2022; 68:103142. [PMID: 34736831 PMCID: PMC8418919 DOI: 10.1016/j.iccn.2021.103142] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Corresponding author at: Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D. Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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25
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Short and long-term complications due to standard and extended prone position cycles in CoViD-19 patients. Intensive Crit Care Nurs 2021; 69:103158. [PMID: 34895799 PMCID: PMC8554071 DOI: 10.1016/j.iccn.2021.103158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate short and long-term complications due to standard (≤24 hours) and extended (>24 hours) prone position in COVID-19 patients. METHODS Retrospective cohort study conducted in an Italian general intensive care unit. We enrolled patients on invasive mechanical ventilation and treated with prone positioning. We recorded short term complications from the data chart and long-term complications from the scheduled follow-up visit, three months after intensive care discharge. RESULTS A total of 96 patients were included in the study. Median time for each prone positioning cycle (302 cycles) was equal to 18 (16-32) hours. In 37 (38%) patients at least one cycle of extended pronation was implemented. Patients with at least one pressure sore due to prone position were 38 (40%). Patients with pressure sores showed a statistically significative difference in intensive care length of stay, mechanical ventilation days, numbers of prone position cycles, total time spent in prone position and the use of extended prone position, compared to patients without pressure sores. All lesions were low grade. Cheekbones (18%) and chin (10%) were the most affected sites. Follow-up visit, scheduled three months after intensive care discharge, was possible in 58 patients. All patients were able to have all 12 muscle groups examined using theMedical Research Council scale examination. No patient reported sensory loss or presence of neuropathic pain for upper limbs. CONCLUSIONS Extended prone position is feasible and might reduce the workload on healthcare workers without significant increase of major prone position related complications.
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26
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Driver VR, Couch KS, Eckert KA, Gibbons G, Henderson L, Lantis J, Lullove E, Michael P, Neville RF, Ruotsi LC, Snyder RJ, Saab F, Carter MJ. The impact of the SARS-CoV-2 pandemic on the management of chronic limb-threatening ischemia and wound care. Wound Repair Regen 2021; 30:7-23. [PMID: 34713947 PMCID: PMC8661621 DOI: 10.1111/wrr.12975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023]
Abstract
In the wake of the coronavirus pandemic, the critical limb ischemia (CLI) Global Society aims to develop improved clinical guidance that will inform better care standards to reduce tissue loss and amputations during and following the new SARS‐CoV‐2 era. This will include developing standards of practice, improve gaps in care, and design improved research protocols to study new chronic limb‐threatening ischemia treatment and diagnostic options. Following a round table discussion that identified hypotheses and suppositions the wound care community had during the SARS‐CoV‐2 pandemic, the CLI Global Society undertook a critical review of literature using PubMed to confirm or rebut these hypotheses, identify knowledge gaps, and analyse the findings in terms of what in wound care has changed due to the pandemic and what wound care providers need to do differently as a result of these changes. Evidence was graded using the Oxford Centre for Evidence‐Based Medicine scheme. The majority of hypotheses and related suppositions were confirmed, but there is noticeable heterogeneity, so the experiences reported herein are not universal for wound care providers and centres. Moreover, the effects of the dynamic pandemic vary over time in geographic areas. Wound care will unlikely return to prepandemic practices. Importantly, Levels 2–5 evidence reveals a paradigm shift in wound care towards a hybrid telemedicine and home healthcare model to keep patients at home to minimize the number of in‐person visits at clinics and hospitalizations, with the exception of severe cases such as chronic limb‐threatening ischemia. The use of telemedicine and home care will likely continue and improve in the postpandemic era.
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Affiliation(s)
- Vickie R Driver
- Wound Healing, Limb Preservation and Hyperbaric Centers, Inova Heart and Vascular Institute Inova Health System, Falls Church, Virginia, USA
| | - Kara S Couch
- Wound Care Services, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Gary Gibbons
- Center for Wound Healing, South Shore Health, Weymouth, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lorena Henderson
- PULSE Amputation Prevention Centers, Affiliates, El Paso Cardiology Associates, P.A., El Paso, Texas, USA
| | - John Lantis
- Mount Sinai West Hospital, Icahn School of Medicine, New York, New York, USA
| | - Eric Lullove
- West Boca Center for Wound Healing, Coconut Creek, Florida, USA
| | - Paul Michael
- Palm Beach Heart & Vascular, JFK Wound Management & Limb Preservation Center, Lake Worth, Florida, USA
| | - Richard F Neville
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA.,Department of Surgery, Inova Health System, Falls Church, Virginia, USA
| | - Lee C Ruotsi
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
| | - Robert J Snyder
- Barry University School of Podiatric Medicine, Miami Shores, Florida, USA
| | - Fadi Saab
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Michigan, USA
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27
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Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors. Intensive Crit Care Nurs 2021; 69:103160. [PMID: 34789437 PMCID: PMC8552588 DOI: 10.1016/j.iccn.2021.103160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation. Methods Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay. Results Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 (IQR 60–83) hours. Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61–2.97), elbow (OR 1.10, 95%CI:0.45–2.68) and wrist (OR 0.97, 95%CI:0.58–1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02–1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses. Conclusion Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.
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28
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Grigatti A, Gefen A. The biomechanical efficacy of a hydrogel-based dressing in preventing facial medical device-related pressure ulcers. Int Wound J 2021; 19:1051-1063. [PMID: 34623741 PMCID: PMC9284629 DOI: 10.1111/iwj.13701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Continuous positive airway pressure masks for breathing assistance are used widely during the coronavirus pandemic. Nonetheless, these masks endanger the viability of facial tissues even after a few hours because of the sustained tissue deformations and extreme microclimate conditions. The risk of developing such device-related pressure ulcers/injuries can be reduced through suitable cushioning materials at the mask-skin interface, to alleviate localised contact forces. Here, we determined the facial tissue loading state under an oral-nasal mask while using hydrogel-based dressing cuts (Paul Hartmann AG, Heidenheim, Germany) for prophylaxis, which is a new concept in prevention of device-related injuries. For this purpose, we measured the compressive mask-skin contact forces at the nasal bridge, cheeks, and chin with vs without these dressing cuts and fed these data to a finite element, adult head model. Model variants were developed to compare strain energy densities and effective stresses in skin and through the facial tissue depth, with vs without the dressing cuts. We found that the dry (new) dressing cuts reduced tissue exposures to loads (above the median loading level) by at least 30% at the nasal bridge and by up to 99% at the cheeks, across the tissue depth. These dressing cuts were further able to maintain at least 65% and 89% of their protective capacity under moisture at the nasal bridge and cheeks, respectively. The hydrogel-based dressings demonstrated protective efficacy at all the tested facial sites but performed the best at the nasal bridge and cheeks, which are at the greatest injury risk.
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Affiliation(s)
- Angela Grigatti
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Fourie A, Ahtiala M, Black J, Hevia H, Coyer F, Gefen A, LeBlanc K, Smet S, Vollman K, Walsh Y, Beeckman D. Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study). J Tissue Viability 2021; 30:466-477. [PMID: 34583874 PMCID: PMC8463934 DOI: 10.1016/j.jtv.2021.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/24/2023]
Abstract
Background Ventilating critically ill patients with acute respiratory distress syndrome in the prone position is a life-saving strategy, but it is associated with adverse consequences such as skin damage. Aim To identify, review and evaluate international proning and skin care guidelines and make an inventory of commonly used equipment and training resources. Design A gap analysis methodology was applied. Methods 1) Comprehensive search and evaluation of proning and skin care guidelines, 2) extensive search and listing equipment and educational resources, and 3) international consultation with 11 experts (8 countries). Data sources A variety of sources researched through July 2021 were used to identify relevant literature: (1) scientific literature databases and clinical trials registries, (2) intensive care and wound care associations, (3) healthcare organisations, (4) guideline development organisations, and (5) the Google search engine. Eleven international experts reviewed the literature and provided insights in two, 2-h online sessions. Findings The search yielded 24 guidelines. One clinical practice guideline had high methodological quality. Twenty-five devices/equipment and sixteen teaching materials were identified and discussed with the expert panel. The gap analysis identified a lack of concise, accessible, evidence-based guidelines and educational materials of short duration. Conclusion This analysis forms the basis for designing a competency-based education and training intervention for an interdisciplinary team caring for the skin of critically ill patients in the prone position. Impact The results can assist the multidisciplinary team to review their current protocol for prone positioning. This is a first step in developing a training package for clinicians.
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Affiliation(s)
- Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Maarit Ahtiala
- Service Division, Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
| | - Joyce Black
- Niedfeft Professor of Nursing, University of Nebraska Medical Center, College of Nursing, Omaha NE, USA.
| | - Heidi Hevia
- Nursing School, Nursing Department, Andres Bello University, Viña del Mar, Chile.
| | - Fiona Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia.
| | - Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
| | - Kim LeBlanc
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Wound Ostomy Continence Institute/Association of Nurses Specialized in Wound Ostomy Continence, Ottawa, ON, Canada.
| | - Steven Smet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Kathleen Vollman
- Advancing Nursing LLC, Adjunct faculty Michigan State University, Northville MI, USA.
| | - Yolanda Walsh
- YL Walsh (Pty) Ltd, Adjunct Lecturer Stellenbosch University, Western Cape, South Africa.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
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30
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Bryant RA, Moore ZE, Iyer V. Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning. Expert Rev Med Devices 2021; 18:833-847. [PMID: 34338565 DOI: 10.1080/17434440.2021.1960505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need. AREAS COVERED This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice. EXPERT OPINION The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).
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Affiliation(s)
- Ruth A Bryant
- Principal Research Scientist/Nursing, President, Association for the Advancement of Wound Care (AAWC), Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Zena Eh Moore
- Director of the Skin Wounds and Trauma (Swat)research Centre, MSc (Leadership in Health Professionals Education), MSc (Wound Healing & Tissue Repair), FFNMRCSI, Professor and Head of the School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Ireland.,Department is School of Medicine, Honorary Visiting Professor, Cardiff University, Cardiff, Wales.,Adjunct Professor, Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Professor, Vakgroep Maatschappelijke Gezondheidkunde, Department of Public Health; Faculteit Geneeskunde En Gezondheidswetenschappen, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium.,Department is School of Nursing, Honorary Professor, Lida Institute, Shanghai, China
| | - Vignesh Iyer
- MS Biotechnology and Clinical Lab Sciences, MSc Biotechnology, Senior Manager, Clinical R&D and Medical Affairs, Bruin Biometrics, LLC, Los Angeles, CA
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Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
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Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Vowden K, Hill L. What is the impact of COVID-19 on tissue viability services and pressure ulceration? J Wound Care 2021; 30:522-531. [PMID: 34256597 DOI: 10.12968/jowc.2021.30.7.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This paper explores and reviews the relevant literature and examines the impact that the first wave of the COVID-19 pandemic has had on the tissue viability service (TVS) and the incidence of pressure ulcers (PUs) in a large UK teaching hospital NHS trust. A comparison has been undertaken of referral data to the TVS during two time periods-Oct-Dec 2019 and April-June 2020. Data show that the PU rate per 1000 beds increased from a pre-pandemic level of around 1 to over 2.7 in the first month of the pandemic, with an increase in device and prone position-related PUs, particularly in the expanded critical care patient population. Even though the bed occupancy decreased, the proportion of ungradable PUs increased, but there was little change in the number of Category 1 and 2 PUs.
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Affiliation(s)
| | - Lisa Hill
- Leeds Teaching Hospitals Trust, Leeds, UK
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Choi MA, Kim MS, Kim C. Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room. J Tissue Viability 2021; 30:331-338. [PMID: 34154878 DOI: 10.1016/j.jtv.2021.06.006] [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: 08/02/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
AIM We aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery. MATERIALS AND METHODS This was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ2 -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%. RESULTS The mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37-340.26), 3.96 (95% CI: 1.13-13.86), and 5.60 times (95% CI: 1.62-19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35-38.00) and 7.93 times (95% CI: 1.45-43.27) for<3 and ≥3 h' duration, respectively. CONCLUSION The difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.
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Affiliation(s)
- Mi Ae Choi
- Master, Unit Manager, Operating Room, Department of Nursing, Busan Korea Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Cheol Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spine Center, Busan Korea Hospital, Busan, South Korea
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34
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Binda F, Galazzi A, Marelli F, Gambazza S, Villa L, Vinci E, Adamini I, Laquintana D. Complications of prone positioning in patients with COVID-19: A cross-sectional study. Intensive Crit Care Nurs 2021; 67:103088. [PMID: 34244027 PMCID: PMC8166520 DOI: 10.1016/j.iccn.2021.103088] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. METHODS Cross-sectional study conducted in the hub COVID-19 centre in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if no unplanned extubation was recorded. The majority of patients (17.5%) experienced bleeding of upper airways. Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04-3.6). CONCLUSION The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.
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Affiliation(s)
- Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Health Sciences Department, University of Florence, Florence, Italy.
| | - Federica Marelli
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Lucia Villa
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Elisa Vinci
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Ileana Adamini
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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Peko L, Ovadia-Blechman Z, Hoffer O, Gefen A. Physiological measurements of facial skin response under personal protective equipment. J Mech Behav Biomed Mater 2021; 120:104566. [PMID: 33945938 DOI: 10.1016/j.jmbbm.2021.104566] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/31/2021] [Accepted: 04/24/2021] [Indexed: 01/14/2023]
Abstract
Medical device-related pressure ulcers (MDRPUs) were traditionally associated with skin-contacting medical devices applied to patients, eventually causing tissue damage. The coronavirus-2019 pandemic has brought a new variant of MDRPUs: facial skin irritation or damage associated with extended use of protective personal equipment (PPE), e.g. facemasks and respirators. In this context, we report here a comprehensive experimental evaluation including facial contact forces, skin temperatures and sub-epidermal moisture (SEM) measurements pre/post-PPE usage, to determine how these physiological parameters change under the effects of surgical facemasks and KN95 respirators and whether such potential changes can explain the commonly reported skin irritation or damage. We found that a surgical mask is potentially less irritating to facial skin than the KN95 respirator, as it applies lower forces and facilitates faster return of facial temperatures to their basal levels. Further, we demonstrated that use of dressing cuts for padding under a KN95 respirator considerably reduced localized forces and did not worsen the thermal and SEM readings at the skin-device contact sites. This study provides a basis for improvement of PPE designs, as it describes physiological measurement methodologies for quantitative comparisons of the effects of different PPE types on facial skin status.
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Affiliation(s)
- Lea Peko
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| | - Zehava Ovadia-Blechman
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Oshrit Hoffer
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
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Yu JN, Wu BB, Feng LP, Chen HL. COVID-19 related pressure injuries in patients and personnel: A systematic review. J Tissue Viability 2021; 30:283-290. [PMID: 33895045 PMCID: PMC8056785 DOI: 10.1016/j.jtv.2021.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/16/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is causing a rapid and tragic health emergency worldwide. Because of the particularity of COVID-19, people are at a high risk of pressure injuries during the prevention and treatment process of COVID-19. OBJECTIVES This systematic review aimed to summarize the pressure injuries caused by COVID-19 and the corresponding preventive measures and treatments. METHODS This systematic review was according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Web of science and CNKI (Chinese) were searched for studies on pressure injuries caused by COVID-19 published up to August 4, 2020. The quality of included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale (NOS) and the CARE guidelines. RESULTS The data were extracted from 16 studies involving 7,696 participants in 7 countries. All studies were published in 2020. There are two main types of pressure injuries caused by the COVID-19: 1) Pressure injuries that caused by protective equipment (masks, goggles and face shield, etc.) in the prevention process; 2) pressure injuries caused by prolonged prone position in the therapy process. CONCLUSIONS In this systematic review, the included studies showed that wearing protective equipment for a long time and long-term prone positioning with mechanical ventilation will cause pressure injuries in the oppressed area. Foam dressing may need to be prioritized in the prevention of medical device related pressure injuries. The prevention of pressure injuries should be our particular attention in the course of clinical treatment and nursing.
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Affiliation(s)
- Jia-Ning Yu
- School of Medicine, Nantong University, 226001, Jiangsu, PR China
| | - Bing-Bing Wu
- School of Medicine, Nantong University, 226001, Jiangsu, PR China
| | - Li-Ping Feng
- Affiliated Hospital of Nantong University, 226001, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, 226001, Jiangsu, PR China.
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The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework. Biomech Model Mechanobiol 2021; 20:851-860. [PMID: 33606118 PMCID: PMC7893381 DOI: 10.1007/s10237-021-01432-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
Pressure ulcers are localized sites of tissue damage which form due to the continuous exposure of skin and underlying soft tissues to sustained mechanical loading, by bodyweight forces or because a body site is in prolonged contact with an interfacing object. The latter is the common cause for the specific sub-class of pressure ulcers termed ‘medical device-related pressure ulcers’, where the injury is known to have been caused by a medical device applied for a diagnostic or therapeutic purpose. Etiological research has established three key contributors to pressure ulcer formation, namely direct cell and tissue deformation, inflammatory edema and ischemic damage which are typically activated sequentially to fuel the injury spiral. Here, we visualize and analyze the above etiological mechanism using a new cell-scale modeling framework. Specifically, we consider here the deformation-inflicted and inflammatory contributors to the damage progression in a medical device-related pressure ulcer scenario, forming under a continuous positive airway pressure ventilation mask at the microarchitecture of the nasal bridge. We demonstrate the detrimental effects of exposure to high-level continuous external strains, which causes deformation-inflicted cell damage almost immediately. This in turn induces localized edema, which exacerbates the cell-scale mechanical loading state and thereby progresses cell damage further in a nonlinear, escalating pattern. The cell-scale quantitative description of the damage cascade provided here is important not only from a basic science perspective, but also for creating awareness among clinicians as well as industry and regulators with regards to the need for improving the design of skin-contacting medical devices.
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Shearer SC, Parsa KM, Newark A, Peesay T, Walsh AR, Fernandez S, Gao WZ, Pierce ML. Facial Pressure Injuries from Prone Positioning in the COVID-19 Era. Laryngoscope 2021; 131:E2139-E2142. [PMID: 33389768 DOI: 10.1002/lary.29374] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE/HYPOTHESIS This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID-19 patients as well as to characterize the location of injuries and treatments provided. METHODS This was a retrospective chart review of 263 COVID-19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two-tailed t-test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. RESULTS Overall, 143 COVID-19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). CONCLUSIONS Facial pressure injuries occur with high incidence in patients with COVID-19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2139-E2142, 2021.
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Affiliation(s)
- Sarah C Shearer
- Department of Otolaryngology/Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Keon M Parsa
- Department of Otolaryngology/Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Annemarie Newark
- Department of Otolaryngology/Head and Neck Surgery, Georgetown University School of Medicine, Washington, District of Columbia, U.S.A
| | - Tejasvi Peesay
- Department of Otolaryngology/Head and Neck Surgery, Georgetown University School of Medicine, Washington, District of Columbia, U.S.A
| | - Amanda R Walsh
- Department of Otolaryngology/Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Stephen Fernandez
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland, U.S.A
| | - William Z Gao
- Department of Otolaryngology/Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Matthew L Pierce
- Department of Otolaryngology/Head and Neck Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, U.S.A
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Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2234] [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: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión [00249], de deterioro de la integridad cutánea [00047] y tisular [00248]. Por su parte, la intervención de enfermería prevención de úlceras por presión [3540], es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas [0204] e integridad tisular: piel y membranas mucosas [1101]. Conclusión: La PP es una terapia coadyuvante recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población.
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Gefen A, Ousey K. COVID-19, fever and dressings used for pressure ulcer prevention: monthly update. J Wound Care 2020; 29:430-431. [DOI: 10.12968/jowc.2020.29.8.430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Karen Ousey
- School of Human and Health Sciences, University of Huddersfield, Queensgate, West Yorkshire, UK
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Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J 2020; 17:1595-1606. [PMID: 32618418 PMCID: PMC7361768 DOI: 10.1111/iwj.13435] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
Prone positioning is used for surgical access and recently in exponentially growing numbers of coronavirus disease 2019 patients who are ventilated prone. To reduce their facial pressure ulcer risk, prophylactic dressings can be used; however, the biomechanical efficacy of this intervention has not been studied yet. We, therefore, evaluated facial soft tissue exposures to sustained mechanical loads in a prone position, with versus without multi‐layered silicone foam dressings applied as tissue protectors at the forehead and chin. We used an anatomically realistic validated finite element model of an adult male head to determine the contribution of the dressings to the alleviation of the sustained tissue loads. The application of the dressings considerably relieved the tissue exposures to loading. Specifically, with respect to the forehead, the application of a dressing resulted in 52% and 71% reductions in soft tissue exposures to effective stresses and strain energy densities, respectively. Likewise, a chin dressing lowered the soft tissue exposures to stresses and strain energy densities by 78% and 92%, respectively. While the surgical context is clear and there is a solid, relevant need for biomechanical information regarding prophylaxis for the prone positions, the projected consequences of the coronavirus pandemic make the present work more relevant than ever before.
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Affiliation(s)
- Lea Peko
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Michelle Barakat-Johnson
- Pressure Injury Prevention and Management, Sydney Local Health District, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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