Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study

Background In neurosurgical procedures where the park bench position is employed, the risk of perioperative pressure injuries is elevated due to the limited contact surface area, with the head and part of the upper torso extending beyond the surgical table. This study aimed to examine the effects of preventative measures against such injuries, proposing a potential standard for postural fixation in these surgeries. Methods Conducted at a medical center, from January 2017 to March 2023, this prospective cohort study involved participants aged 20 and above who underwent neurosurgical procedures in the park bench position under general anesthesia. The focus was on comparing the incidence of pressure injuries between intervention and control groups. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Out of 65 patients enrolled, 28 were assigned to each of the intervention and control groups. The control group experienced 17 instances of postoperative pressure injuries and skin disorders in areas prone to pressure, such as the axillary and greater trochanter regions. Conversely, the intervention group reported no such incidents, underscoring the efficacy of meticulous surgical positioning and management of bodily pressure, temperature, humidity, and microclimate. Conclusion Implementing preventive measures in neurosurgical park bench procedures significantly reduces the incidence of postoperative pressure injuries and skin disorders. These findings advocate for the adoption of standardized postural fixation protocols in such surgeries, potentially influencing global clinical practices in neurosurgery.

Multilayered silicone foam dressings potentially used for preventing recurrence of pressure injuries: A bench-to-clinical bedside study

AIM

This study aimed to evaluate the use of multilayered silicone foam dressings for preventing pressure injury recurrence by reducing friction, pressure, and shear force at skin sites where previous pressure injuries closed.

METHODS

A bench-to-clinical bedside investigation was conducted. In the bench, three multilayered silicone foam dressings were assessed. The simulated skin-shearing test consisted of a weight, a polyurethane-based skin model containing a three-axis tactile sensor, dressings, a table covered with bedsheets, and a mechanical tester. The mechanical tester simultaneously measured the interface friction force and internal shear force and pressure continuously during skin model movements. No-dressing was used as a negative control. In clinical bedside assessments, a multilayered silicone foam dressing with lower friction and shear force was applied to two bedridden patients. Photographs and ultrasound images were used to assess the recurrence of pressure injury.

RESULTS

The dressings significantly reduced friction, pressure, and shear force compared with these parameters in the negative control. No significant differences in the shear forces between the dressings were observed. One clinical case did not develop a new pressure injury reaching the dermis. However, the second case developed a new pressure injury within one month after the first pressure injury closed.

CONCLUSION

Our bench-to-clinical bedside study revealed that multilayered silicone foam dressings can potentially prevent pressure injury recurrence.

A model for predicting 7-day pressure injury outcomes in paediatric patients: A machine learning approach

AIMS

We sought to explore factors associated with early pressure injury progression and build a model for predicting these outcomes using a machine learning approach.

DESIGN

A retrospective cohort study.

METHODS

In this study, we recruited paediatric patients, with hospital-acquired stage I pressure injury or suspected deep tissue injury, who met the inclusion criteria between 1 January 2015-31 October 2018. We divided patients into two groups, namely healing or delayed healing, then followed them up for 7 days. We analysed patient pressure injury characteristics, demographics, treatment, clinical situation, vital signs, and blood test results, then build prediction models using the Random Forest and eXtreme Gradient Boosting approaches.

RESULTS

The best prediction model, trained and tested using Random Forest with 10 variables, achieved an accuracy, sensitivity, specificity, and area under the curve of 0.82 (SD 0.06), 0.80 (SD 0.08), 0.84 (SD 0.08), and 0.89 (SD 0.06), respectively. The most contributing variables, in order of importance, included serum creatinine, red blood cell, and haematocrit.

CONCLUSION

An awareness of specific conditions and areas that could lead to delayed healing pressure injury in paediatric patients is needed.

IMPACT

This evidence-based prediction model, coupled with the aforementioned clinical indicators, is expected to enhance early prediction of outcomes in paediatric patients thereby improve the quality of care and the outcome of children with PIs.