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Radovanović N, Krajnc M, Gorenjak M, Strdin Košir A, Markota A. Adverse Events during Prone Positioning of Patients with COVID-19 during a Surge in Hospitalizations-Results of an Observational Study. NURSING REPORTS 2024; 14:1781-1791. [PMID: 39051368 PMCID: PMC11270212 DOI: 10.3390/nursrep14030132] [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: 04/22/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to determine the prevalence of adverse events in mechanically ventilated adults with COVID-19 who have undergone prone positioning. A total of 100 patients were included retrospectively; 60% were males, the mean age was 64.8 ± 9.1 years, and hospital mortality was 47%. In all, we recorded 118 removals of catheters and tubes in 66 patients; 29.6% were removals of a nasogastric tube, 18.6% of an arterial line, 14.4% of a urinary catheter, and 12.7% of a central venous catheter. Reintubation or repositioning of a tracheotomy tube was required in 19 patients (16.1%), and cardiopulmonary resuscitation in 2 patients (1.7%). We recorded a total of 184 pressure ulcers in 79 patients (on anterior face in 38.5%, anterior thorax in 23.3% and any extremity anteriorly in 15.2%). We observed that body weight (p = 0.021; β = 0.09 (CI95: 0.01-0.17)) and the cumulative duration of prone positioning (p = 0.005; β = 0.06 (CI95: 0.02-0.11)) were independently associated with the occurrence of any adverse event. The use of prone positioning in our setting was associated with a greater number of adverse events than previously reported. Body weight and cumulative duration of prone positioning were associated with the occurrence of adverse events; however, other factors during a COVID-19 surge, such as working conditions, staffing, and staff education, could also have contributed to a high prevalence of adverse events.
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Affiliation(s)
- Nataša Radovanović
- Infectious Diseases Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Mateja Krajnc
- Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Mario Gorenjak
- Centre for Human Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia;
| | - Alenka Strdin Košir
- Infectious Diseases Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Andrej Markota
- Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Chang W. Influence of severity of illnesses on risk of death in intensive care unit patients with severity of pressure injuries as mediating variable. Int Wound J 2024; 21:e14623. [PMID: 38149748 PMCID: PMC10961870 DOI: 10.1111/iwj.14623] [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: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow-up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death.
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Affiliation(s)
- Wen‐Pei Chang
- Department of NursingShuang Ho Hospital, Taipei Medical UniversityNew Taipei CityTaiwan
- School of NursingCollege of Nursing, Taipei Medical UniversityTaipeiTaiwan
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Marshall V, Qiu Y, Jones A, Weller CD, Team V. Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review. J Adv Nurs 2024; 80:1262-1282. [PMID: 37788102 DOI: 10.1111/jan.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
AIM(S) To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. DESIGN Exploratory. METHODS Scoping review. DATA SOURCES Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). RESULTS Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). CONCLUSION Quality of evidence was low for the interventional studies and best practice recommendations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. IMPACT STATEMENT This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. REPORTING METHOD We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people. PROTOCOL REGISTRATION Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
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Affiliation(s)
- Victoria Marshall
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Baran Z, Özden D. Retrospective investigation of pressure injury in COVID-19 patients followed on invasive mechanical ventilator support. J Tissue Viability 2024; 33:144-149. [PMID: 38184472 DOI: 10.1016/j.jtv.2023.10.001] [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: 01/16/2023] [Revised: 08/31/2023] [Accepted: 10/08/2023] [Indexed: 01/08/2024]
Abstract
AIM In this study, we aimed to investigate pressure injury (PI) and its associated factors in COVID-19 patients receiving invasive mechanical ventilation (IMV). METHODS This was designed as a retrospective, descriptive and correlational study. In this study, there was no sample selection, and the data were collected by reviewing the files of 438 patients who had been followed up on IMV in the intensive care unit (ICU) with a diagnosis of COVID-19 between April 30, 2020, and April 30, 2022. The collected data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS) program. RESULTS A total of 305 pressure injuries occurred in 36.3% of 438 patients receiving IMV. It was found that the length of IMV stay of the patients accelerated the occurrence of PI and that the length of stay in the intensive care unit, albumin and hemoglobin levels, Braden Pressure Sore Risk Assessment Score, APACHE-II value, nutritional status, glutamine supplementation, and vasopressor use were found to be significantly correlated with the incidence of PI (p < 0.05). CONCLUSIONS Patients with COVID-19 who were followed up on IMV had a high incidence of PI, and prolonged ICU stays and intubations duration as well as low albumin and hemoglobin levels increased the occurrence of PI. Hence, it is recommended that the PI risk levels of COVID-19 patients followed up on IMV should be evaluated frequently and nursing interventions should be implemented according to the evaluations.
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Affiliation(s)
- Zilan Baran
- Faculty of Nursing, The Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkiye.
| | - Dilek Özden
- Fundamentals of Nursing Department, The Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkiye.
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Nadeem R, Chirayath-Wilson N, D'souza JP, Dsouza FS, Thomas BP, Mathew M, Sharma E, Zahra AN, Ignacio RAS, Cherian MS, Basheer I, Kokash F, Memon M, Tariq R. Pressure injury incidence and impact on patients treated with prone positioning for COVID-19 ARDS. J Wound Care 2023; 32:500-506. [PMID: 37572338 DOI: 10.12968/jowc.2023.32.8.500] [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] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To determine the incidence of pressure injuries (PIs) and their impact on clinical outcomes in patients treated with prone positioning for COVID-19 acute respiratory distress syndrome (ARDS). METHOD All patients with COVID-19 ARDS who were treated with prone positioning were categorised as cases and those who were not treated with prone positioning were categorised as controls. Demographics, clinical data and confounding variables affecting outcomes were recorded. Outcome variables of mortality and length of stay in intensive care units (ICUs) for both groups were recorded. Both groups' incidence of PIs were recorded and compared using statistical tests. Fisher's exact test was used for categorical variables, and Mann-Whitney U test was used for continuous variables. RESULTS The sample included 212 patients, treated with prone position (n=104) and without prone treatment (n=108). The incidence of PIs was n=75 (35.4%). PIs were significantly higher in patients in the prone position (n=51, 49%) compared with patients who were not (n=24, 22%); p=0.001. Patients in the prone position were found to have lower APACHE-2 scores, longer stays on the ventilator, ICU and in the hospital. CONCLUSION PIs are more prevalent in patients in the prone position and it adversely impacts clinical outcomes; it prolongs the length of stay on the ventilator, in the ICU and in the hospital.
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Affiliation(s)
- Rashid Nadeem
- Department of Intensive Care, Dubai Hospital, Dubai, UAE
| | | | | | | | | | | | - Ekta Sharma
- Dubai Hospital, Medical Department, Dubai. UAE
| | | | | | | | | | | | - Marvi Memon
- Ross University, Department of Medicine, Barbados
| | - Rana Tariq
- Dubai Hospital, Department of Physiotherapy, Dubai, Al Baraha, UAE
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Bolgeo T, Maconi A, Gardalini M, Gatti D, Di Matteo R, Lapidari M, Longhitano Y, Savioli G, Piccioni A, Zanza C. The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients. J Pers Med 2023; 13:jpm13050736. [PMID: 37240907 DOI: 10.3390/jpm13050736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the 'Scale for the Assessment of Narrative Review Articles' (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Menada Gardalini
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Denise Gatti
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Roberta Di Matteo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Marco Lapidari
- Department of Vascular Surgery, St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Gabriele Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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de Souza GKC, Kaiser DE, Morais PP, Boniatti MM. Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients. Aust Crit Care 2023; 36:195-200. [PMID: 35232616 DOI: 10.1016/j.aucc.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Pressure injury is damage to the skin and underlying soft tissue that occurs in response to intense and/or prolonged skin pressure. The Braden scale is the most used in health services to assess pressure injury. However, this scale was not specifically developed for critically ill patients. The Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) scale was developed for patients in intensive care units. OBJECTIVE The objective of this study was to compare the accuracy of the CALCULATE scale with that of Braden in predicting the risk of pressure injury in critically ill patients. METHODS This was a prospective cohort study, involving patients who did not have pressure injury on admission to the intensive care unit of a tertiary hospital in the city of Porto Alegre, Brazil. Data collection took place between January and July 2020 using the Braden and CALCULATE scales, in addition to clinical and sociodemographic variables. Patients were followed up until discharge from the intensive care unit or death. RESULTS Fifty-one patients were included in the study. Of these, 29 (56.9%) developed pressure injury. To predict pressure injury onset, the areas under the receiver operator characteristic curve of the Braden scale on the first day and the lowest score during the first 3 days were 0.71 (0.56-0.86) and 0.70 (0.53-0.87), respectively. The areas under the receiver operator characteristic curve of the CALCULATE scale on the first day and the highest score during the first 3 days were 0.91 (0.82-0.99) and 0.92 (0.85-1.00), respectively. In the logistic regression analysis, the CALCULATE scale on the first day remained an independent predictor of pressure injury onset after controlling for age and length of stay in the intensive care unit. CONCLUSION We found that the CALCULATE scale may be more accurate than the Braden scale as a tool to assess the risk of developing pressure injury in critically ill patients.
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Daigné D, Blanchard PY, Allain MC, Lambert G, Rodriguez S, Tessier B, Blayau C, Voiriot G, Bérard L, Rousseau A, Fartoukh M. Feasibility of a repositioning schedule on pressure ulcer prevention in a French Intensive Care Unit: A pre and post-intervention pilot study. J Tissue Viability 2023; 32:20-25. [PMID: 36599729 DOI: 10.1016/j.jtv.2022.12.007] [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: 06/29/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
AIMS As a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale. DESIGN A single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines. METHODS During the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers' adherence and workload, and the rate of adverse events. RESULTS In the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90). CONCLUSION A personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial.
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Affiliation(s)
- Daisy Daigné
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Pierre-Yves Blanchard
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Marie-Cécile Allain
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Gwendoline Lambert
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Séverine Rodriguez
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Benjamin Tessier
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Clarisse Blayau
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Guillaume Voiriot
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Laurence Bérard
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Paris, France.
| | - Alexandra Rousseau
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Paris, France.
| | - Muriel Fartoukh
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
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Walter T, Zucman N, Mullaert J, Thiry I, Gernez C, Roux D, Ricard JD. Extended prone positioning duration for COVID-19-related ARDS: benefits and detriments. Crit Care 2022; 26:208. [PMID: 35804453 PMCID: PMC9263064 DOI: 10.1186/s13054-022-04081-2] [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: 03/17/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the COVID-19 pandemic, many more patients were turned prone than before, resulting in a considerable increase in workload. Whether extending duration of prone position may be beneficial has received little attention. We report here benefits and detriments of a strategy of extended prone positioning duration for COVID-19-related acute respiratory distress syndrome (ARDS). Methods A eetrospective, monocentric, study was performed on intensive care unit patients with COVID-19-related ARDS who required tracheal intubation and who have been treated with at least one session of prone position of duration greater or equal to 24 h. When prone positioning sessions were initiated, patients were kept prone for a period that covered two nights. Data regarding the incidence of pressure injury and ventilation parameters were collected retrospectively on medical and nurse files of charts. The primary outcome was the occurrence of pressure injury of stage ≥ II during the ICU stay. Results For the 81 patients included, the median duration of prone positioning sessions was 39 h [interquartile range (IQR) 34–42]. The cumulated incidence of stage ≥ II pressure injuries was 26% [95% CI 17–37] and 2.5% [95% CI 0.3–8.8] for stages III/IV pressure injuries. Patients were submitted to a median of 2 sessions [IQR 1–4] and for 213 (94%) prone positioning sessions, patients were turned over to supine position during daytime, i.e., between 9 AM and 6 PM. This increased duration was associated with additional increase in oxygenation after 16 h with the PaO2/FiO2 ratio increasing from 150 mmHg [IQR 121–196] at H+ 16 to 162 mmHg [IQR 124–221] before being turned back to supine (p = 0.017). Conclusion In patients with extended duration of prone position up to 39 h, cumulative incidence for stage ≥ II pressure injuries was 26%, with 25%, 2.5%, and 0% for stage II, III, and IV, respectively. Oxygenation continued to increase significantly beyond the standard 16-h duration. Our results may have significant impact on intensive care unit staffing and patients’ respiratory conditions. Trial registration: Institutional review board 00006477 of HUPNVS, Université Paris Cité, APHP, with the reference: CER-2021-102, obtained on October 11th 2021. Registered at Clinicaltrials (NCT05124197). Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04081-2.
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Lee SY, Oh DK, Hong SB, Lim CM, Huh JW. Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit. Korean J Intern Med 2022; 37:1186-1194. [PMID: 36127798 PMCID: PMC9666256 DOI: 10.3904/kjim.2021.546] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU. METHODS We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics. RESULTS We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011). CONCLUSION The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, "friction and shear" was associated with the development of pressure injuries in ICU patients.
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Affiliation(s)
- Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen 2022; 30:498-508. [PMID: 35589532 DOI: 10.1111/wrr.13021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
The present study was designed to determine the association between Acute Physiology and Chronic Health Evaluation (APACHE) scale and elevated pressure injure (PI) risk in intensive care units (ICU) and also evaluate the predictive value of APACHE score in PI patients. Comprehensive strategies were used to search studies from PubMed, Web of Science, and Ovid Embase electronic databases for observational studies that provided data about APACHE scores related to PI in ICU. Eligible studies were selected based on inclusion and exclusion criteria. The pooled SMD with 95% confidence intervals were calculated. A summary ROC curve was plotted to calculate area under curve (AUC) for APACHE-II (15-20). Twenty-one studies involving 11,102 patients who met selection criteria were included. The 11.0% of patients (1229/11102) in ICU developed PIs. Overall, the PI group had a higher score compared with the non-PI group in the APACHE II (22.1 ± 8.0 vs. 14.5 ± 7.4, mean ± SD). The APACHE-III of PI patients was significantly more than that in the non-PI group (79.9 ± 25.6 vs. 59.9 ± 30.4, mean ± SD). The pooled SMD was 0.82 (95% CI: 0.58-1.06, I2 = 91.7%, p-value < 0.001). The subgroup analysis revealed that the risk of PIs did not vary with the type of APACHE score (II, III, IV) and the type of study design (case-control, cross-sectional, cohort, longitudinal study). Proportion of males (I2 = 91.68%, p value = 0.090), publish year (I2 = 91.96%, p value = 0.187) and mean age of patients (I2 = 91.96%, p value = 0.937) were not the sources of heterogeneity. APACHE-II (15-20) achieves the best predictive performance in PI, and the prediction accuracy was balanced with equal sensitivity and specificity (Sen: 0.72, 0.62-0.80; Spec: 1.72, 1.25-2.38). In conclusion, higher APACHE scores are frequently accompanied by a higher incidence of PI among critical-care patients. APACHE-II scores (15-20) satisfactorily predicted PI, and strategies to prevent PI should be aggressively implemented.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Man-Li Zha
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Cox J, Edsberg LE, Koloms K, VanGilder CA. Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:21-28. [PMID: 35040812 PMCID: PMC9200225 DOI: 10.1097/won.0000000000000834] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.
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Affiliation(s)
- Jill Cox
- Correspondence: Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, 180 University Ave. Newark, NJ 07102 ()
| | - Laura E. Edsberg
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Kimberly Koloms
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Catherine A. VanGilder
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
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Hu B, Zhao Y, Yang J, Zeng Z, Wu Y, Gui C, Gong J, Gao Y, Yang Y, Luo C, Wang Y, Jiang Q, Guo W, Lu P, Yuan F, Li X, Dai X. Frequency of and risk factors for intensive care unit-acquired sacrum pressure injuries in critically ill patients: A multicenter cross-sectional study in China. Health Sci Rep 2021; 4:e390. [PMID: 34722934 PMCID: PMC8532509 DOI: 10.1002/hsr2.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Hospital-acquired pressure injuries (HAPI) prolong hospital stays and are an important health problem worldwide. The aim of this study was to assess the frequency of and risk factors for intensive care unit (ICU)-acquired pressure injuries (IAPI) on the sacrum in critically ill patients in China. METHODS We performed a multicenter, cross-sectional survey of IAPI on the sacrum in 23 adult ICUs in 19 hospitals in China. Data for 421 critically ill patients were collected on December 13, 2019, and January 13, 2020, including patient characteristics, physiological, and clinical information. Logistic regression was used to analyze the risk factors for IAPI on the sacrum in the ICU. RESULTS Forty-one patients presented sacrum pressure injuries in the ICU, with a frequency of 9.74%. Risk factors that significantly increased the risk of IAPI on the sacrum were lower body mass index (BMI, odds ratio [OR] = 1.115, confidence interval [CI]: 1.011-1.229, P = .029), chronic obstructive pulmonary disease (COPD, OR = 3.183, CI: 1.261-8.037, P = .014), multiple organ dysfunction syndrome (MODS, OR = 2.670, CI: 1.031-6.903, P = .043), and a lower Braden risk score (OR = 1.409, CI: 1.197-1.659, P < .001). CONCLUSION Lower BMI, COPD, MODS, and lower Braden risk score are independent risk factors for sacrum IAPI in China.
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Affiliation(s)
- Binqin Hu
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Yang Zhao
- Department of Critical Care MedicineThe Fourth People's Hospital of ChenzhouChenzhouChina
| | - Jijun Yang
- Department of Critical Care MedicineCentral Hospital of LoudiLoudiChina
| | - Zhenhua Zeng
- Department of Critical Care MedicineNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yanhong Wu
- Department of Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Chunmei Gui
- Department of Critical Care MedicineThe First People's Hospital of ChangdeChangshaChina
| | - Jiang Gong
- Department of Intensive Care MedicineThe Third People's Hospital of LonggangShenzhenChina
| | - Yi Gao
- Department of Critical Care MedicineXiangya Boai Rehabilitation Hospital, Central South UniversityChangshaChina
| | - Yong Yang
- Department of Critical Care MedicineChangsha Central Hospital, University of South ChinaChangshaChina
| | - Cuizhu Luo
- Department of Critical Care MedicineJiangXi Pingxiang People's HospitalPingxiangChina
| | - Yu Wang
- Department of Critical Care MedicineThe Third People's Hospital of YongzhouYongzhouChina
| | - Qingjuan Jiang
- Department of Critical Care Medicinethe First Affiliated Hospital, Hunan College of Traditional Chinese MedicineZhuzhouChina
| | - Wenlong Guo
- Department of Critical Care MedicineThe First People's Hospital of YueyangYueyangChina
| | - Pan Lu
- Department of Critical Care MedicineThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityShenzhenChina
| | - Fen Yuan
- Department of Critical Care MedicineThe Second People's Hospital of ShenzhenShenzhenChina
| | - Xiaofang Li
- Department of OstomyAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Xingui Dai
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
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Alderden J, Amoafo L, Zhang Y, Fife C, Yap D, Yap T. Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study. JMIR DERMATOLOGY 2021; 4:e29757. [PMID: 37632818 PMCID: PMC10334951 DOI: 10.2196/29757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the "outside in" as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the "inside out" due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device-related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.
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Affiliation(s)
| | - Linda Amoafo
- University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- University of Utah, Salt Lake City, UT, United States
| | | | - David Yap
- University of Utah, Salt Lake City, UT, United States
| | - Tracey Yap
- Duke University, Durham, NC, United States
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15
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Alderden J, Cadavero A, Dougherty D, Jung SH, Yap T. Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury: A Retrospective Cohort Study. Adv Skin Wound Care 2021; 34:412-416. [PMID: 34081637 PMCID: PMC8716002 DOI: 10.1097/01.asw.0000752700.00049.b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI. METHODS Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data. RESULTS The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53-0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17-4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00-1.02; P = .009). CONCLUSIONS Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.
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Affiliation(s)
- Jenny Alderden
- University of Utah college of Nursing, Salt Lake City, UT
| | | | | | - Se-Hee Jung
- University of Utah college of Nursing, Salt Lake City, UT
| | - Tracey Yap
- Duke University School of Nursing, Durham, NC
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16
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Supervised machine learning-based prediction for in-hospital pressure injury development using electronic health records: A retrospective observational cohort study in a university hospital in Japan. Int J Nurs Stud 2021; 119:103932. [PMID: 33975074 DOI: 10.1016/j.ijnurstu.2021.103932] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In hospitals, nurses are responsible for pressure injury risk assessment using several kinds of risk assessment scales. However, their predictive validity is insufficient to initiate targeted preventive strategy for each patient. The use of electronic health records with machine learning technique is a promising strategy to provide automated clinical decision-making aid. OBJECTIVE The purpose of this study was to construct a predictive model for pressure injury development which included feature variables that can be collected on the first day of hospitalization by nurses who routinely input the data to electronic health records. DESIGN Retrospective observational cohort study. SETTING This study was conducted at a university hospital in Japan. PARTICIPANTS This study used electronic health records, which include entry/discharge records, basic nursing records, and pressure injury management documents (N = 75,353). METHODS The outcome measure was the pressure injuries which developed outside of an operation theatre and frequently appeared on the specific body parts at high risk of pressure injury development. We utilized four major classifiers: logistic regression, random forest, linear support vector machine, and extreme gradient boosting (XGBoost) with 5-fold cross-validation technique. The area under the receiver operating characteristic curve (AUC) was used for evaluating predictive performance. RESULTS The proportion of hospital-acquired pressure injuries was 0.52%. The receiver operating characteristic curves revealed the best predictive performance for the XGBoost model, achieving the highest sensitivity of 0.78±0.03 and AUC of 0.80±0.02 amongst four types of classifiers. Variables related to difficulty in activities of daily living, anorexia, and respiratory or cardiac disorders were extracted as important features. CONCLUSIONS Our findings suggest that routinely collected health data by nurses on the first day of patient admission have the potential to help determine high-risk patients for pressure injury development. Tweetable abstract: Machine learning models on routinely collected electronic health records data successfully predict pressure injury development during hospitalization. FUNDING This work was supported by a JSPS KAKENHI Grant-in-Aid for Exploratory Research (16K15865).
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Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, Calvino-Gunther S, Chaboyer W, Coyer F, Deschepper M, François G, Honore PM, Jankovic R, Khanna AK, Llaurado-Serra M, Lin F, Rose L, Rubulotta F, Saager L, Williams G, Blot SI. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med 2021; 47:160-169. [PMID: 33034686 PMCID: PMC7880913 DOI: 10.1007/s00134-020-06234-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. METHODS International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. RESULTS Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3). CONCLUSION Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
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Affiliation(s)
- Sonia O Labeau
- Nursing Department, Faculty of Education, Health and Social Work, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elsa Afonso
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
- Neonatal Intensive Care Unit, Rosie Maternity, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Carole Boulanger
- Intensive Care Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Stephen J Brett
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Wendy Chaboyer
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Fiona Coyer
- School of Nursing, Royal Brisbane and Women's Hospital, Queensland University of Technology and Intensive Care Services (ICS), Herston, Australia
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Mieke Deschepper
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Guy François
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Patrick M Honore
- Intensive Care Department, CHU Brugmann University Hospital, Brussels, Belgium
| | - Radmilo Jankovic
- Department for Anesthesia and Intensive Care, School of Medicine, University of Nis, Niš, Serbia
| | - Ashish K Khanna
- Section on Critical Care Medicine, Department of Anesthesiology, Critical Illness, Injury Recovery and Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | | | - Frances Lin
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Sunnybrook Research Institute, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Toronto, Canada
- Prolonged-Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Canada
| | - Francesca Rubulotta
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Leif Saager
- Klinik für Anaesthesiologie, Universitaetsmedizin Goettingen, Göttingen, Germany
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - Ged Williams
- Al Mafraq Hospital, Abu Dhabi, United Arab Emirates
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Stijn I Blot
- Nursing Department, Faculty of Education, Health and Social Work, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
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Fulbrook P, Mbuzi V, Miles S. Incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care: A systematic review and meta-analysis. Int J Nurs Stud 2021; 114:103826. [PMID: 33352437 DOI: 10.1016/j.ijnurstu.2020.103826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. OBJECTIVES To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care. DESIGN Systematic review and meta-analysis of incidence and prevalence REVIEW METHODS: Articles published in English between 2009 and 2018, reporting pressure injury as a primary outcome were selected based on inclusion criteria. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted. Sub-group meta-analyses were conducted to investigate potential causes of heterogeneity. RESULTS Fifteen studies met the criteria for inclusion in the systematic review, of which 14 were incidence studies. Heterogeneity was significant and there was large observed variance between studies. The 95% confidence interval of cumulative incidence across all 14 studies, with an overall sample size of 6371, was 9.8-25.6%. In 11 studies that included all-stage pressure injury the 95% confidence interval was 8.3-28.3%. In seven studies in which Stage 1 pressure injury was excluded, the 95% confidence interval was 5.8-22.7%. In the single prevalence study included, which excluded Stage 1 pressure injury, prevalence was 8.8%. CONCLUSIONS The incidence of pressure injury in cardiac intensive care patients was similar to that found in general intensive care patients. However, our results suggest that the incidence may be significantly higher in cardiac surgical patients admitted to intensive care. There were significant differences across the various studies in the ways in which data were collected and reported. Further well-designed studies are required to better understand incidence in this population, using standardised methods of data collection and reporting.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Vainess Mbuzi
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.
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An Experimental Intervention Study Assessing the Impact of a Thin Silicone Gel Surface Overlay on Interface Pressure. Radiol Res Pract 2020; 2020:3246531. [PMID: 33299607 PMCID: PMC7710438 DOI: 10.1155/2020/3246531] [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: 06/18/2020] [Revised: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The incidence of pressure ulcers (PUs) presents a substantial threat to patients, especially geriatric patients, those with restricted mobility, and patients suffering from chronic diseases such as cancer. PUs creates a huge financial burden on healthcare authorities and patients, costing billions to treat and manage. Radiography and radiotherapy patients may experience medical device related (MDR) PUs and studies have shown that high interface pressure (IP) values exist for the head when placed on an X-ray table without a mattress. These high IP values pose a PU risk to patients, especially those accessing prolonged radiography/radiology and radiotherapy procedures. The current study assessed the impact on IP values for the head from using a thin silicone gel surface overlay during radiographic procedures and identified whether this reduced the risk of PUs. Materials and Methods A calibrated XSENSOR pressure mat was used to measure IP for the head on an X-ray table with and without a thin silicone gel surface overlay. Prior to pressure mapping, the silicone gel surface overlay was assessed for its impact on radiation attenuation and image quality. Results Study participants were 14 males (70%) and six females (30%), with an age range of 25-53 years (mean = 34.4 ± 7.0). Paired-samples t-test results indicated that there was a statistically significant decrease in the mean IP for the head on the X-ray table without the silicone gel surface overlay (mean = 83.9 ± 8.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 62.4 ± 6.1 in mmHg), p ≤ 0.001. Paired-samples t-test results indicated that there was a statistically significant decrease in the mean peak pressure index (PPI) for the head on the X-ray table without the silicone gel surface overlay (mean = 205.1 ± 28.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 159.8 ± 26.8 in mmHg), p ≤ 0.001. Conclusions The use of a thin silicone gel surface overlay could reduce IP risk for the head by approximately 25%. The reduction in IP risk could have a significant impact in reducing the risk of developing a PU. To ensure maximum benefit, the silicone gel surface overlay should be evaluated to address the specific needs within radiography and radiotherapy planning and treatment settings.
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Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J 2020; 17:1924-1934. [PMID: 32830460 DOI: 10.1111/iwj.13482] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital-acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital-acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score-adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in-hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30-, 60-, and 90-day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital-acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.
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Koepp J, Baron MV, Hernandes Martins PR, Brandenburg C, Kira ATF, Trindade VD, Ley Dominguez LM, Carneiro M, Frozza R, Possuelo LG, De Mello Pinto MV, Mahlmann Kipper L, Pinheiro da Costa BE. The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores. JMIR Mhealth Uhealth 2020; 8:e14266. [PMID: 32470916 PMCID: PMC7327590 DOI: 10.2196/14266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Background The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. Objective The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. Methods This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. Results The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. Conclusions In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. Trial Registration PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137
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Affiliation(s)
- Janine Koepp
- University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil.,Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Miriam Viviane Baron
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Coordination of Improvement of Higher Education Personnel - Brazil, Brasília, Brazil
| | | | - Cristine Brandenburg
- Federal University of Ceará, Fortaleza, Brazil.,National Council for Scientific and Technological Development - Brazil, Brasilia, Brazil
| | | | - Vanessa Devens Trindade
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,National Council for Scientific and Technological Development - Brazil, Brasilia, Brazil
| | | | | | - Rejane Frozza
- University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
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Johansen E, Lind R, Sjøbø B, Petosic A. Moisture associated skin damage (MASD) in intensive care patients: A Norwegian point-prevalence study. Intensive Crit Care Nurs 2020; 60:102889. [PMID: 32536519 DOI: 10.1016/j.iccn.2020.102889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Critically ill patients are at risk of developing moisture associated skin damage and pressure ulcers. These conditions may co-exist and be difficult to distinguish, but a simultaneous investigation may provide a true prevalence. OBJECTIVES To investigate the prevalence of moisture associated skin damage and associated factors among Norwegian intensive care patients. METHODS A multi-centre one-day point-prevalence study. RESULTS Totally, 112 patients participated in the study. Overall, 15 patients (13%, 15/112) had some type of moisture associated skin damage of which six cases (5%, 6/112) were related to faeces and/or urine (incontinence associated dermatitis). Skin breakdown occurred primarily in the pelvic area. Overall, 87% (97/112) had an indwelling urinary catheter. Stools were reported in 42% (47/112) of the patients on the study day, mostly liquid or semi-liquid. Overall, 11% (12/112) had a faecal management system. Only a few care plans for moisture associated skin damage prevention and care existed. CONCLUSION Patients in this study were vulnerable to skin breakdown in the pelvic area. Nevertheless, a low prevalence of skin breakdown existed. This may relate to intensive care nurses' qualifications, the 1:1 nurse-patient staffing, the high prevalence of urinary catheters and few patients having stools.
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Affiliation(s)
- Edda Johansen
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Brønnbakken 42, 3038 Drammen, Norway.
| | - Ranveig Lind
- Department of Health and Care Sciences, Harstad, Faculty of Health Sciences, UiT - The Arctic University of Norway, Norway; University Hospital of North Norway, Intensive Care Unit, Tromsø, Norway
| | - Britt Sjøbø
- Department of Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Antonija Petosic
- Oslo University Hospital, Division of Emergencies and Critical Care, Department of Postoperative and Intensive Care, University of Oslo, Faculty of Medicine, Institute of Health and Society, Norway
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Effect of Hydrogel Enriched With Alginate, Fatty Acids, and Vitamins A and E on Pressure Injuries: A Case Series. Plast Surg Nurs 2020; 39:87-94. [PMID: 31441788 DOI: 10.1097/psn.0000000000000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pressure injuries are a common kind of skin lesion that may be difficult to treat. The objective of this study was to analyze the effect of hydrogel enriched with alginate, fatty acids, and vitamins A and E in the treatment of pressure injuries. This case series with 12-week follow-up included applying daily dressings with hydrogel, maintaining a photographic record, using planimetry to calculate the lesion area, and classifying the healing process using the Pressure Ulcer Scale for Healing (PUSH). In addition, exudate collection from the ulcers was performed in the beginning and after 12 weeks of treatment to determine the dosage of metalloproteinase 9 (MMP9) and tissue inhibitor of metalloproteinase 1 (TIMP1). Of the 13 patients included in the study, 2 died and 11 were monitored for 12 weeks. Only 1 patient showed full wound healing, but all patients showed a significant 12.19% (p = .023) reduction in the lesion area. The PUSH score was also significantly reduced from 15.9 to 10.54 (p = .0052). Relative to the dosage of metalloproteinase and its inhibitor, there was a reduction in the level of MMP9 and there was no change in the level of TIMP1. This study showed that hydrogel enriched with alginate, fatty acids, and vitamins A and E provided promising results for the treatment of pressure injuries by reducing the lesion area, the general PUSH score, and the amount of MMP9 in the wounds' microenvironment.
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Nakagami G, Morita K, Matsui H, Yasunaga H, Fushimi K, Sanada H. Association between pressure injury status and hospital discharge to home: a retrospective observational cohort study using a national inpatient database. ACTA ACUST UNITED AC 2020. [DOI: 10.37737/ace.2.2_38] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
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Song YP, Shen HW, Cai JY, Zha ML, Chen HL. The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis. Int Wound J 2019; 16:1533-1544. [PMID: 31606950 DOI: 10.1111/iwj.13243] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta-analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle-Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta-regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta-analysis. A survival curve between two groups by individual patient-level was drew. Eight studies with 5523 elderly patients were included in the analysis. Follow-up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46-2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08-5.37) were higher than stage 1-4 and 2-4 pressure injuries (HR: 1.66; 95% CI: 1.35-2.05; HR: 1.74; 95% CI: 1.16-2.60). The meta-regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient-level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79-2.14) in elderly patients. Our meta-analysis indicated that patients complicated with pressure injuries are estimated to have a two times higher risk on mortality compared with patients without pressure injuries during the 3 years follow-up period. Particular attention should be given to the elderly patients who are at higher risk for mortality.
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Affiliation(s)
- Yi-Ping Song
- School of Nursing, Nantong University, Nantong, China
| | - Hong-Wu Shen
- Affiliated Hospital of Nantong University, Nantong, China
| | - Ji-Yu Cai
- School of Nursing, Nantong University, Nantong, China
| | - Man-Li Zha
- Affiliated Hospital of Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Hödl M, Voithofer C. [Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients]. Pflege 2019; 32:181-187. [PMID: 31084289 DOI: 10.1024/1012-5302/a000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients Abstract. Background: Internationally, it is recommended to use the clinical view with a validated instrument for pressure ulcer risk assessment to determine subsequent measures. We could not identify any study investigating risk assessment and subsequent measures for mobile / chairfast / bedfast patients. Aim of the study: To identify the degree of agreement between the Bradenscale and clinical view regarding pressure ulcer risk in mobile / chairfast / bedfast patients and subsequent preventive measures. Method: Data from 5274 hospital patients from the "Nursing quality measurement 2015", a cross-sectional multicenter study, were collected. Results: Out of all mobile, chairfast or bedfast patients assessed as at risk of pressure ulcer with the Bradenscale, 22.3 % (mobile), 61.7 % (chairfast) and 86.1 % (bedfast) were also assessed as at risk by clinical view. More than 3 / 4 of the chairfast patients that were not at risk according to clinical view received preventive measures. Conclusion: The consequences over time for patients that received no measures due to discrepancies in the risk assessments should be focused. Furthermore the evaluation of measures in patients without a risk of pressure ulcer is of critical importance. The aspect of patient mobility deserves special attention due to the low agreement of the risk assessments in chairfast and mobile patients.
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Affiliation(s)
- Manuela Hödl
- 1 Institut für Pflegewissenschaft, Medizinische Universität Graz
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Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU. Adv Skin Wound Care 2019; 32:359-364. [DOI: 10.1097/01.asw.0000553599.20444.f4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nyide SP, Brysiewicz P, Bruce J, Clarke DL. A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal. Curationis 2019; 42:e1-e5. [PMID: 31038327 PMCID: PMC6489142 DOI: 10.4102/curationis.v42i1.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.
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Affiliation(s)
- Spumelelo P Nyide
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Abstract
BACKGROUND Use of pressure ulcer risk assessment tools or scales is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines, however it is not known whether using a risk assessment tool makes a difference to patient outcomes. We conducted a review to provide a summary of the evidence pertaining to pressure ulcer risk assessment in clinical practice, and this is the third update of this review. OBJECTIVES To assess whether using structured and systematic pressure ulcer risk assessment tools, in any healthcare setting, reduces the incidence of pressure ulcers. SEARCH METHODS In February 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the use of structured and systematic pressure ulcer risk assessment tools with no structured pressure ulcer risk assessment, or with unaided clinical judgement, or RCTs comparing the use of different structured pressure ulcer risk assessment tools. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, 'Risk of bias' assessment and GRADE assessment of the certainty of evidence. MAIN RESULTS We included two studies in this review (1,487 participants). We identified no new trials for this latest update.Both studies were undertaken in acute-care hospitals. In one study, patients were eligible if they had a Braden score of 18 or less. In the second study all admitted patients were eligible for inclusion, once they were expected to have a hospital stay of more than three days and they had been in hospital for no more than 24 hours before baseline assessment took place. In the first study, most of the participants were medical patients; no information on age or gender distribution was provided. In the second study, 50.3% (619) of the participants were male, with a mean age of 62.6 years (standard deviation (SD): 19.3), and 15.4% (190) were admitted to oncology wards.The two included studies were three-armed studies. In the first study the three groups were: Braden risk assessment tool and training (n = 74), clinical judgement and training (n = 76) and clinical judgement alone (n = 106); follow-up was eight weeks. In the second study the three groups were: Waterlow risk assessment tool (n = 411), clinical judgement (n = 410) and Ramstadius risk assessment tool (n = 410); follow-up was four days. Both studies reported the primary outcome of pressure ulcer incidence and one study also reported the secondary outcome, severity of new pressure ulcers.We are uncertain whether use of the Braden risk assessment tool and training makes any difference to pressure ulcer incidence, compared to risk assessment using clinical judgement and training (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.53 to 1.77; 150 participants), or compared to risk assessment using clinical judgement alone (RR 1.43, 95% CI 0.77 to 2.68; 180 participants). We assessed the certainty of the evidence as very low (downgraded twice for study limitations and twice for imprecision).Risk assessment using the Waterlow tool may make little or no difference to pressure ulcer incidence, or to pressure ulcer severity, when compared to risk assessment using clinical judgement (pressure ulcers of all stages: RR 1.10, 95% CI 0.68 to 1.81; 821 participants; stage 1 pressure ulcers: RR 1.05, 95% CI 0.58 to 1.90; 821 participants; stage 2 pressure ulcers: RR 1.25, 95% CI 0.50 to 3.13; 821 participants), or risk assessment using the Ramstadius tool (pressure ulcers of all stages: RR 1.41, 95% CI 0.83 to 2.39; 821 participants; stage 1 pressure ulcers: RR 1.16, 95% CI 0.63 to 2.15; 821 participants; stage 2 pressure ulcers: RR 2.49, 95% CI 0.79 to 7.89; 821 participants). Similarily, risk assessment using the Ramstadius tool may make little or no difference to pressure ulcer incidence, or to pressure ulcer severity, when compared to risk assessment using clinical judgement (pressure ulcers of all stages: RR 0.79, 95% CI 0.46 to 1.35; 820 participants; stage 1 pressure ulcers: RR 0.90, 95% CI 0.48 to 1.68; 820 participants; stage 2 pressure ulcers: RR 0.50, 95% CI 0.15 to 1.65; 820 participants). We assessed the certainty of the evidence as low (downgraded once for study limitations and once for imprecision).The studies did not report the secondary outcomes of time to ulcer development, or pressure ulcer prevalence. AUTHORS' CONCLUSIONS We identified two studies which evaluated the effect of risk assessment on pressure ulcer incidence. Based on evidence from one study, we are uncertain whether risk assessment using the Braden tool makes any difference to pressure ulcer incidence, compared with training and risk assessment using clinical judgement, or risk assessment using clinical judgement alone. Risk assessment using the Waterlow tool, or the Ramstadius tool may make little or no difference to pressure ulcer incidence, or severity, compared with clinical judgement. The low, or very low certainty of evidence available from the included studies is not reliable enough to suggest that the use of structured and systematic pressure ulcer risk assessment tools reduces the incidence, or severity of pressure ulcers.
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Affiliation(s)
- Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Declan Patton
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
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Complications and their associations following the surgical repair of pressure ulcers. Am J Surg 2018; 216:1177-1181. [DOI: 10.1016/j.amjsurg.2018.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/15/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022]
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Unavoidable Pressure Injuries, Terminal Ulceration, and Skin Failure: In Search of a Unifying Classification System. Adv Skin Wound Care 2018; 30:200-202. [PMID: 28426565 DOI: 10.1097/01.asw.0000515077.61418.44] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse 2018; 37:e1-e11. [PMID: 28765361 DOI: 10.4037/ccn2017548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models' predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value.
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Affiliation(s)
- Xiaohong Deng
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ting Yu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ailing Hu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. .,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University. .,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University.
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Otero TMN, Canales C, Yeh DD, Elsayes A, Belcher DM, Quraishi SA. Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients. Nutr Clin Pract 2018; 34:142-147. [PMID: 30101993 DOI: 10.1002/ncp.10184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients. METHODS We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit. RESULTS A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL. CONCLUSION In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.
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Affiliation(s)
- Tiffany M N Otero
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts.,Department of Medicine, Carney Hospital, Boston, Massachusetts
| | - Cecilia Canales
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, University of California, Irvine, California
| | - D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Ali Elsayes
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Donna M Belcher
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Loudet CI, Marchena MC, Maradeo MR, Fernández SL, Romero MV, Valenzuela GE, Herrera IE, Ramírez MT, Palomino SR, Teberobsky MV, Tumino LI, González AL, Reina R, Estenssoro E. Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study. Rev Bras Ter Intensiva 2018; 29:39-46. [PMID: 28444071 PMCID: PMC5385984 DOI: 10.5935/0103-507x.20170007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/17/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle". Results: Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor. Conclusion: A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.
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Affiliation(s)
- Cecilia Inés Loudet
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina.,Disciplina de Farmacologia Aplicada, Seção de Terapia Intensiva, Facultad de Ciencias Médicas, Universidad Nacional de La Plata - La Plata, Buenos Aires, Argentina
| | - María Cecilia Marchena
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Roxana Maradeo
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Laura Fernández
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Victoria Romero
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Graciela Esther Valenzuela
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Isabel Eustaquia Herrera
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Martha Teresa Ramírez
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Rojas Palomino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Mariana Virginia Teberobsky
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Leandro Ismael Tumino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Ana Laura González
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Rosa Reina
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Elisa Estenssoro
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
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Barakat-Johnson M, Barnett C, Wand T, White K. Medical device-related pressure injuries: An exploratory descriptive study in an acute tertiary hospital in Australia. J Tissue Viability 2017; 26:246-253. [DOI: 10.1016/j.jtv.2017.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/25/2022]
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Forriez O, Masseline J, Coadic D, David V, Trouiller P, Sztrymf B. Efficacy and safety of a new coverlet device on skin microclimate management: a pilot study in critical care patients. J Wound Care 2017; 26:51-57. [PMID: 28182521 DOI: 10.12968/jowc.2017.26.2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the effect of a new coverlet device, allowing air circulation at the body/underlying surface interface, on skin microclimate management. METHOD This prospective observational pilot study took place in a 15-bed university-affiliated intensive care unit. Overall, 34 mechanically ventilated patients were included. Skin humidity and temperature were monitored before and after the implementation of the tested device at the occiput, scapulas, buttocks and sacrum. Humidity and temperature were evaluated through surface skin impedance and an infra-red thermometer, respectively. Health professionals were asked to evaluate the device. RESULTS After implementation of the coverlet device, there was a rapid, sustained and significant decrease in skin humidity at all sites ranging from 6 % to 15 %, excluding the occiput. Skin temperature also significantly decreased from 1 % at both scapulas, but not at the other studied body sites. No side effects were observed. Health professionals reported that the device was easy and quick to install. Although they did not report a subjective improvement in skin moisture or temperature, they considered the device to be efficient. CONCLUSION Although limited by its design, this pilot study suggests a good efficacy of the studied device on skin microclimate management. Further data are warranted to test the clinical implications of our findings.
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Affiliation(s)
| | - J Masseline
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - D Coadic
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - V David
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - P Trouiller
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France
| | - B Sztrymf
- Service de réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris Sud, Clamart, France; INSERM U999, Université Paris Sud, Le plessis Robinson, France
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Baron MV, Reuter CP, Burgos MS, Cavalli V, Brandenburg C, Krug SBF. Experimental study with nursing staff related to the knowledge about pressure ulcers. Rev Lat Am Enfermagem 2016; 24:e2831. [PMID: 27878223 PMCID: PMC5173304 DOI: 10.1590/1518-8345.1134.2831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/14/2016] [Indexed: 11/22/2022] Open
Abstract
Objective to compare the scores of knowledge in teams participating or not participating in educational interventions about pressure ulcers. Method a quantitative study with experimental design. Data were collected through a validated questionnaire. The study included 71 individuals, including nurses and nursing technicians from three intensive care units, divided into intervention group and control group. Data analysis considered the scores of the groups in the moment before and after intervention. To check the average rate of correct answers, we calculated the mean and standard deviation. We carried out the Mann-Whitney test for analysis of two independent samples, and the Wilcoxon test for related samples. Results The mean percentage of correct answers, at the baseline was 74.1% (SD = 26.4) in the intervention group and 76.0% (SD = 22.9) in the control group and post time -intervention, was 87.8% (SD = 18.8) in the group receiving educational intervention, considering that in the control group it was 79.1% (SD = 22.2). The group that participated in educational interventions did not reach the proper average of 90% correct answers for the test. Conclusion educational interventions on staging, evaluation and prevention of pressure ulcers contributed significantly to the increase of correct responses score in the knowledge test of the intervention group and improved their knowledge on the subject.
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Affiliation(s)
- Miriam Viviane Baron
- MSc, Researcher, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cézane Priscila Reuter
- MSc, Assistant Professor, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Miria Suzana Burgos
- PhD, Full Professor, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Veniria Cavalli
- Intensive care specialist, RN, Hospital Santa Cruz, Santa Cruz do Sul, RS, Brazil
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Levine JM. Skin Failure: An Emerging Concept. J Am Med Dir Assoc 2016; 17:666-9. [DOI: 10.1016/j.jamda.2016.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/20/2016] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
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Chen CM, Lai CC, Cheng KC, Weng SF, Liu WL, Shen HN. Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:354. [PMID: 26423892 PMCID: PMC4589902 DOI: 10.1186/s13054-015-1071-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure. METHODS The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV. RESULTS The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality. CONCLUSIONS ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.
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Affiliation(s)
- Chin-Ming Chen
- Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Road., Rende District, Tainan, 71710, Taiwan. .,Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yungkang District, Tainan, 710, Taiwan. .,Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan.
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying District, 201, Taikang, Taikang Village, Liouying District, Tainan, 736, Taiwan.
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. .,Department of Safety, Health and Environment, Chung Hwa University of Medical Technology, 89, Wenhua 1st Street, Rende District, Tainan, 717, Taiwan.
| | - Shih-Feng Weng
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. .,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wei-Lun Liu
- Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. .,Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying District, 201, Taikang, Taikang Village, Liouying District, Tainan, 736, Taiwan.
| | - Hsiu-Nien Shen
- Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. .,Department of Public Health, College of Medicine, National Cheng Kung University, 1, University Road, Tainan, 701, Taiwan.
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