Risk factors affecting pressure ulcer healing: Impact of prescription medications

Factors associated with facial pressure injury in patients receiving non-invasive positive pressure ventilation mask: A retrospective case-control study

AIMS AND OBJECTIVES

This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non-invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI.

BACKGROUND

Non-invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal-oral NIPPV masks and discomfort in contact with the skin surface.

DESIGN

A retrospective case-control study.

METHODS

From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under-mask prophylactic dressings during hospitalisation. Patients were divided into the non-FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case-control study.

RESULTS

There were significant differences between the groups in age, serum albumin, C-reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176-2.260)], BMI [OR = 0.396 (0.210-1.784)] and corticosteroids [OR = 0.394 (0.159-1.811)], which were predictors of FPI in patients with NIPPV.

CONCLUSIONS

Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high-risk and timely preventive measures to reduce FPI.

RELEVANCE TO CLINICAL PRACTICE

Addressing FPI-related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks.

Repair of pressure ulcers in the elderly using autologous microskin implantation and negative pressure wound therapy: A retrospective study

BACKGROUND

Pressure ulcers remain a worldwide problem.

OBJECTIVE

To introduce an intermittent and feasible wound treatment method for the treatment of pressure ulcers in elderly patients.

METHODS

This surgical procedure was performed on eight elderly patients suffering from pressure ulcers. Microskin measuring 0.1 × 0.1 centimeters was cut from a small amount of thin skin and then grafted onto the wound surface in conjunction with closed negative pressure therapy.

RESULTS

Seven patients had their wounds closed after a single surgery, while one patient required two surgeries to close the wound.

CONCLUSION

Autologous microskin implantation for the treatment of pressure ulcers in the elderly is an effective method to close the wound, which can prevent the elderly from living with wounds in their later years and is a viable treatment option.

Factors affecting severity of pressure ulcers: Impact of number of medications

Polypharmacy, which refers to the situation of a patient taking more medications than is clinically necessary, has become a major problem in recent years. Although the effects of medications on pressure ulcers have been reported, there are no reports on the impact of the total number of medications on pressure ulcers. The purpose of this study was to investigate the effect of number of medications on the severity of pressure ulcers. Participants included 94 patients who were admitted to Chiba University Hospital with pressure ulcers between April 2013 and March 2021. Univariate analysis identified ulcer depth, weight loss and anticoagulant use to be factors that contributed to the severity of pressure ulcers. Multiple regression analysis was performed for six variables, namely, the number of medications, ulcer depth, weight loss and anticoagulant use, as well as diabetes status and total serum protein level, which have been reported to be associated with pressure ulcers in previous studies. The following independent risk factors were identified: weight loss (β 0.207, 95% confidence interval [CI] 0.700-3.193; p = 0.003), anticoagulant use (β 0.161, 95% CI 0.271-3.088; p = 0.020) and ulcer depth (β 0.719, 95% CI 7.172-10.329; p < 0.001). The number of medications was not a significant factor. This study revealed that the number of medications a patient is taking does not affect the severity of pressure ulcers. The findings should provide useful information for the management of pressure ulcers.

Mortality related to pressure ulcers in Czech Republic - Analyses of national health registries

BACKGROUND

Pressure ulcers/pressure injuries (PUs/PIs) relate to decreasing quality of life, prolonged hospitalisation, the increased economic cost of care, and increased mortality. That's why this study focused on one of the mentioned factors - mortality.

OBJECTIVES

The study analyses national data in the Czech Republic to map the mortality phenomenon comprehensively based on data from national health registries.

METHOD

The retrospective, nationwide cross-sectional data analysis of data collected by the National Health Information System (NHIS) has been provided in the period 2010-2019 with a special focus on 2019. Hospitalisations with PUs/PIs were identified by reporting L89.0-L89.9 diagnosis as a primary or secondary hospitalisation diagnosis. We also included all the patients who died in the given year with an L89 diagnosis reported in 365 days prior the death.

RESULTS

In 2019, 52.1% of patients with reported PUs/PIs were hospitalised, and 40.8% were treated on an outpatient basis. The most common underlying cause of death mortality diagnosis (43.7%) in these patients was the diseases of the circulatory system. Patients who die in a healthcare facility while hospitalised with an L89 diagnosis generally have a higher category of PUs/PIs than persons who die outside a healthcare facility.

CONCLUSION

The proportion of patients dying in a health facility is directly proportional to the increasing PUs/PIs category. In 2019, 57% of patients with PUs/PIs died in a healthcare facility, and 19% died in the community. In 24% of patients who died in the healthcare facility, PUs/PIs were reported 365 days before the death.

Retrospective evaluation of the effectiveness of using two different products in preventing the development of pressure injuries in patients undergoing lung lobectomy

AIM

This retrospective study aims to determine the impacts of two different products (barrier cream, barrier spray) routinely used before surgery on the development of postoperative pressure injuries in patients undergoing lung lobectomy.

MATERIALS AND METHODS

In the study, the researchers retrospectively examined the data of 60 patients who underwent lobectomy in a university hospital's thoracic surgery clinic between 12.02.2021 and 14.02.2022. The patients were divided into two groups: those to whom a barrier cream was applied (30) and those to whom a barrier spray was applied. The Patient Description Form and the Braden Risk Assessment Tool were used in data collection. The Mann-Whitney U and Kruskal-Wallis tests were conducted for statistical analyses.

RESULTS

In the study, the development rates of blanchable erythema and stage I pressure injuries in the sacral and dorsal regions were significantly higher in patients to whom a barrier spray was applied than in patients to whom a barrier cream was applied (p < 0.05). Pain intensity in the sacral and dorsal regions was significantly lower in patients to whom a barrier cream was applied than those to whom a barrier spray was applied (p < 0.05).

CONCLUSION

Blanchable erythema and intraoperative pressure injury were observed less in patients in whom a barrier cream was used before surgery. Surgical nurses should first evaluate the risk in the preoperative period in the clinics and benefit from the use of barrier cream to prevent the development of blanchable erythema and intraoperative pressure injury.

Accelerated Wound Border Closure Using a Microemulsion Containing Non-Inhibitory Recombinant α1-Antitrypsin

Wound healing requires a non-compromising combination of inflammatory and anti-inflammatory processes. Human α1-antitrypsin (hAAT), a circulating glycoprotein that rises during acute-phase responses and during healthy pregnancies, is tissue-protective and tolerance-inducing; although anti-inflammatory, hAAT enhances revascularization. hAAT blocks tissue-degrading enzymes, including neutrophil elastase; it is, therefore, unclear how wound healing might improve under hAAT-rich conditions. Here, wound healing was examined in the presence of recombinant hAAT (hAAT^WT) and protease-inhibition-lacking hAAT (hAAT^CP). The impact of both hAAT forms was determined by an epithelial cell gap closure assay, and by excisional skin injuries via a microemulsion optimized for open wounds. Neutrophilic infiltration was examined after 8 h. According to results, both hAAT forms accelerated epithelial gap closure and excisional wound closure, particularly at early time points. Unlike dexamethasone-treated wounds, both resulted in closed borders at the 8-h time point. In untreated and hAAT^CP-treated wounds, leukocytic infiltrates were widespread, in hAAT^WT-treated wounds compartmentalized and in dexamethasone-treated wounds, scarce. Both hAAT forms decreased interleukin-1β and increased VEGF gene expression. In conclusion hAAT improves epithelial cell migration and outcomes of in vivo wounds irrespective of protease inhibition. While both forms of hAAT allow neutrophils to infiltrate, only native hAAT created discrete neutrophilic tissue clusters.

Identifying the Risk Factors Associated with Nursing Home Residents' Pressure Ulcers Using Machine Learning Methods

BACKGROUND

Machine learning (ML) can keep improving predictions and generating automated knowledge via data-driven predictors or decisions.

OBJECTIVE

The purpose of this study was to compare different ML methods including random forest, logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM in terms of their accuracy, sensitivity, specificity, negative predictor values, and positive predictive values by validating real datasets to predict factors for pressure ulcers (PUs).

METHODS

We applied representative ML algorithms (random forest, logistic regression, linear SVM, polynomial SVM, radial SVM, and sigmoid SVM) to develop a prediction model (N = 60).

RESULTS

The random forest model showed the greatest accuracy (0.814), followed by logistic regression (0.782), polynomial SVM (0.779), radial SVM (0.770), linear SVM (0.767), and sigmoid SVM (0.674).

CONCLUSIONS

The random forest model showed the greatest accuracy for predicting PUs in nursing homes (NHs). Diverse factors that predict PUs in NHs including NH characteristics and residents' characteristics were identified according to diverse ML methods. These factors should be considered to decrease PUs in NH residents.

Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study

PURPOSE

Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit.

METHODS

The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform.

RESULTS

The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%.

CONCLUSIONS

The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.