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Mezzalira E, Ambrosi E, Askew N, Nherera L, Searle R, Fatoye F, Forni C. Economic Evaluation of Multilayer Silicone-Adhesive Polyurethane Foam Dressing for the Prevention of Pressure Ulcers in at-risk Hospitalized Patients: US and Italian Perspective. Int J Health Policy Manag 2024; 13:8371. [PMID: 39624869 PMCID: PMC11806223 DOI: 10.34172/ijhpm.8371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 11/09/2024] [Indexed: 02/11/2025] Open
Abstract
BACKGROUND Hospital-acquired pressure ulcers (HAPUs) constitute an important source of concern for healthcare systems due to their negative consequences on patient quality of life and hospital costs. This phenomenon is increasing worldwide, driven by an aging population and increasing prevalence of chronic conditions. This economic evaluation aimed to determine whether using a multilayer, silicone-adhesive polyurethane foam dressing shaped for the sacrum area, alongside standard prevention (SP), is cost-effective in preventing HAPUs for hospitalized patients compared to SP alone. METHODS We developed a decision-analytic model to estimate the expected costs and clinical benefits of using the polyurethane foam dressing from Italian and US payor perspectives. Model inputs were taken from published studies, and uncertainty was assessed using one-way and probabilistic sensitivity analyses (PSA). RESULTS From both US and Italian perspectives, using a foam dressing in addition to SP was found to be cost-saving in all hospital settings. That is, it reduced the incidence of HAPUs at a lower cost overall. The estimated savings were €179 per patient and $305 per patient from Italian and US perspectives. Following sensitivity analysis, the results remained cost-saving, suggesting that our findings are robust. CONCLUSION This is the first economic analysis investigating the cost-effectiveness of preventive dressings and standard prevention for avoiding sacral pressure ulcers for at-risk hospitalized patients. This analysis suggests that using a multilayer polyurethane foam dressing to prevent sacral HAPUs in at-risk hospitalized patients is a cost-effective strategy compared with standard prevention alone and, therefore, should be considered as a strategy for PU prevention in hospital settings.
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Affiliation(s)
- Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | - Francis Fatoye
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024; 33:642-651. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [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: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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Amin R, Farid J, Sheikh MA, Irfan M, Rahman S, Faraj Mursal SN. Statistical and cross-sectional analysis of factors effecting the prevalence of pressure ulcer in hospital admitted stroke patients. J Tissue Viability 2024; 33:631-641. [PMID: 38997904 DOI: 10.1016/j.jtv.2024.06.004] [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: 05/28/2023] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 07/14/2024]
Abstract
Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.
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Affiliation(s)
| | | | - Muhammad Aman Sheikh
- Department of Electronics and Computer Systems Engineering, Cardiff School of Technologies, United Kingdom.
| | - Muhammad Irfan
- Electrical Engineering Department, College of Engineering, Najran University, Najran, 61441, Saudi Arabia
| | - Saifur Rahman
- Electrical Engineering Department, College of Engineering, Najran University, Najran, 61441, Saudi Arabia
| | - Salim Nasar Faraj Mursal
- Electrical Engineering Department, College of Engineering, Najran University, Najran, 61441, Saudi Arabia
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Hlebichuk J, Buck E, Brooker AL, Mackenzie JK, Cleary MB, Singh M, Hook M. Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries. Dimens Crit Care Nurs 2024; 43:246-252. [PMID: 39074228 DOI: 10.1097/dcc.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs). OBJECTIVES To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest. METHOD This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression. RESULTS The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03). DISCUSSION Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.
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Yang J, Yang X, Xiong ZY. Effect of emotion management and nursing on patients with painless induced abortion after operation. World J Psychiatry 2024; 14:1182-1189. [PMID: 39165548 PMCID: PMC11331380 DOI: 10.5498/wjp.v14.i8.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND With an estimated 121 million abortions following unwanted pregnancies occurring worldwide each year, many countries are now committed to protecting women's reproductive rights. AIM To analyze the impact of emotional management and care on anxiety and contraceptive knowledge mastery in painless induced abortion (IA) patients. METHODS This study was retrospective analysis of 84 patients with IA at our hospital. According to different nursing methods, the patients were divided into a control group and an observation group, with 42 cases in each group. Degree of pain, rate of postoperative uterine relaxation, surgical bleeding volume, and postoperative bleeding volume at 1 h between the two groups of patients; nursing satisfaction; and mastery of contraceptive knowledge were analyzed. RESULTS After nursing, Self-Assessment Scale, Depression Self-Assessment Scale, and Hamilton Anxiety Scale scores were 39.18 ± 2.18, 30.27 ± 2.64, 6.69 ± 2.15, respectively, vs 45.63 ± 2.66, 38.61 ± 2.17, 13.45 ± 2.12, respectively, with the observation group being lower than the control group (P < 0.05). Comparing visual analog scales, the observation group was lower than the control group (4.55 ± 0.22 vs 3.23 ± 0.41; P < 0.05). The relaxation rate of the cervix after nursing, surgical bleeding volume, and 1-h postoperative bleeding volumes were 25 (59.5), 31.72 ± 2.23, and 22.41 ± 1.23, respectively, vs 36 (85.7), 42.39 ± 3.53, 28.51 ± 3.34, respectively, for the observation group compared to the control group. The observation group had a better nursing situation (P < 0.05), and higher nursing satisfaction and contraceptive knowledge mastery scores compared to the control group (P < 0.05). CONCLUSION The application of emotional management in postoperative care of IA has an ideal effect.
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Affiliation(s)
- Jing Yang
- Gynecological Clinic, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongii Medical College, Huazhong University of Science & Technology, Wuhan 430000, Hubei Province, China
| | - Xiao Yang
- Gynecological Clinic, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongii Medical College, Huazhong University of Science & Technology, Wuhan 430000, Hubei Province, China
| | - Zhuo-Ya Xiong
- Gynecological Clinic, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongii Medical College, Huazhong University of Science & Technology, Wuhan 430000, Hubei Province, China
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Bates-Jensen BM, Crocker J, Nguyen V, Robertson L, Nourmand D, Chirila E, Laayouni M, Offendel O, Peng K, Romero SA, Fulgentes G, McCreath HE. Decreasing Intraoperative Skin Damage in Prone-Position Surgeries. Adv Skin Wound Care 2024; 37:413-421. [PMID: 39037095 DOI: 10.1097/asw.0000000000000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery. METHODS In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data. RESULTS Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants. CONCLUSIONS Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.
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Affiliation(s)
- Barbara M Bates-Jensen
- At the University of California, Los Angeles (UCLA), Los Angeles, California, US, Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, Los Angeles School of Nursing and David Geffen School of Medicine; Jessica Crocker, BA, is Project Director, Division of Geriatrics, David Geffen School of Medicine; and Vicky Nguyen, MSN, is Graduate Student, School of Nursing. Lauren Robertson, BS, is Senior Quality Control Analytical Associate, ImmunityBio, Los Angeles, California. Deborah Nourmand, MSN, RN, is Registered Nurse, UCLA Santa Monica Surgery Center, Santa Monica, CA. At the School of Nursing, UCLA, Emily Chirila, BSN, is Nursing Student; Mohamed Laayouni, MSN, is Nursing Student; Ofelia Offendel, MSN, is Student Nurse; Kelly Peng, BA, is Graduate Student Research Assistant; and Stephanie Anne Romero, MSN, is Graduate Student Researcher. Gerry Fulgentes, MSN, RN, CWOCN, PCCN, is Clinical Manager, Wounds, Ostomy, and Continence Services, UCLA Santa Monica Medical Center. Heather E. McCreath, PhD, is Adjunct Professor, Division of Geriatrics, David Geffen School of Medicine, UCLA
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Schallom M, Tymkew H, Taylor B, Prentice D, Vyers K, Duensing E, Brougham N, Licare J, Arroyo C. Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study. Dimens Crit Care Nurs 2024; 43:184-193. [PMID: 38787773 DOI: 10.1097/dcc.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Changes in healthcare delivery were required during the first year of the COVID-19 pandemic. OBJECTIVE The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting. METHOD A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission. RESULTS Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001). DISCUSSION The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.
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Ramirez-Marin HA, Contreras-Yañez I, Campos-Jimenez KI, Molina-Murrieta L, Huerta-Ramirez Y, Domínguez-Cherit JG. Pressure ulcers related to prone positioning: a pandemic amidst a pandemic. J Wound Care 2024; 33:451-460. [PMID: 38843014 DOI: 10.12968/jowc.2021.0105] [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: 08/23/2024]
Abstract
OBJECTIVE To explore the epidemiology and risk factors associated with the development of pressure ulcers (PUs) in patients receiving prone positioning (PP) ventilatory therapy; to compare the inflammatory status of patients who develop PUs with those who do not; and to describe the experience and useful findings that have allowed us to improve the management of these patients to reduce the incidence of PUs. METHOD An observational, descriptive and longitudinal study was conducted, where sociodemographic and laboratory data were collected from patients who were hospitalised and required PP ventilatory therapy in critical care areas (CCA) during the months of May-October 2020. RESULTS From the total number of patients who required PP during their CCA stay (n=240), 202 (84.2%) developed a PU. The four most frequent areas where a PU appeared were: the head and neck (n=115); the pinna (n=21); the torso (n=21); and the lower limbs (n=21). Patients who developed PU were more frequently males with higher initial levels of creatinine phosphokinase and ferritin. The incidence for each month of follow-up decreased from 8.3% to 5.8%. CONCLUSION Regardless of the intervention, a multidisciplinary approach is required to optimise the prevention and treatment of these wounds. While PUs are often the result of other medical conditions or poor health status in general, the vast majority of PUs are avoidable.
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Affiliation(s)
| | - Irazu Contreras-Yañez
- Early Rheumatoid Arthritis Clinic, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Mexico City, Mexico
| | - Karin Ivette Campos-Jimenez
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City. Mexico
| | - Leticia Molina-Murrieta
- Wound and Ostomy Clinic, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Mexico City, Mexico
| | - Yeni Huerta-Ramirez
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Mexico City, Mexico
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Lucchini A, Villa M, Maino C, Alongi F, Fiorica V, Lipani B, Ponzetta G, Vigo V, Rezoagli E, Giani M. The occurrence of pressure injuries and related risk factors in patients undergoing extracorporeal membrane oxygenation for respiratory failure: A retrospective single centre study. Intensive Crit Care Nurs 2024; 82:103654. [PMID: 38387296 DOI: 10.1016/j.iccn.2024.103654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Limited data is available regarding the incidence of pressure injuries in patients who have undergone Extracorporeal Membrane Oxygenation (ECMO), a life-saving technique that provides respiratory support for hypoxemia that does not respond to conventional treatment. AIM To assess the incidence of pressure injuries and identify the risk factors in Acute Respiratory Distress Syndrome patients receiving ECMO. METHODS A retrospective observational study utilizing prospectively collected data was performed in an Italian intensive care unit, between 1 January 2012 and 30 April 2022 enrolling all consecutive patients with Acute Respiratory Distress Syndrome who underwent ECMO. RESULTS One hundred patients were included in this study. 67 patients (67%) developed pressure injuries during their intensive care unit stay, with a median of 2 (1-3) sites affected. The subgroup of patients with pressure injuries was more hypoxic before ECMO implementation, received more frequent continuous renal replacement therapy and prone positioning, and showed prolonged ECMO duration, intensive care unit and hospital length of stay compared to patients without pressure injuries. The logistic model demonstrated an independent association between the pO2/FiO2 ratio prior to ECMO initiation, the utilization of the prone positioning during ECMO, and the occurrence of pressure injuries. CONCLUSIONS The incidence of pressure injuries was elevated in patients with Adult Respiratory Distress Syndrome who received ECMO. The development of pressure injuries was found to be independently associated with hypoxemia before ECMO initiation and the utilization of prone positioning during ECMO. IMPLICATIONS FOR CLINICAL PRACTICE Patients who require ECMO for respiratory failure are at a high risk of developing pressure injuries. To ensure optimal outcomes during ECMO implementation and treatment, it is vital to implement preventive measures and to closely monitor skin health in at-risk areas.
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Affiliation(s)
- Alberto Lucchini
- Direction of Health and Social Professions, General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza - University of Milano-Bicocca, Italy.
| | - Marta Villa
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clara Maino
- Direction of Health and Social Professions, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Francesca Alongi
- Cardiologic Intensive Care Unit, ASST GOM Niguarda, Milano, Italy
| | | | - Barbara Lipani
- General ICU - A.O.U.I. Verona Policlinico G.B. Rossi, Italy
| | - Giuseppe Ponzetta
- Centro Sanitario Bregaglia - Pronto Soccorso, Promontogno, Svizzera, Switzerland.
| | - Veronica Vigo
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Marco Giani
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
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He Y, Yue J, Teng Y, Fan Z, Jia M, Teng H, Zhuge L. Tryptanthrin promotes pressure ulcers healing in mice by inhibiting macrophage-mediated inflammation via cGAS/STING pathways. Int Immunopharmacol 2024; 130:111687. [PMID: 38382260 DOI: 10.1016/j.intimp.2024.111687] [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: 11/18/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Pressure ulcers (PUs) is ischemic necrosis caused by long-term local tissue pressure, directly affecting postoperative functional recovery. There is evidence that inflammation has an adverse impact on the development of PUs and contributes to unfavorable outcomes, suggesting that blocking the inflammatory response may be a promising therapeutic strategy for PUs. Tryptanthrin (Tryp), a natural product isolated from indigenous plants, has an anti-inflammatory biological function. However, the efficacy of Tryp in PUs remains unclear. METHODS Efficacy of Tryp suppressed inflammation was assessed using magnets-induced PUs model in mice. Hematoxylin-Eosin staining, masson staining and immunohistochemistry were used to evaluate the histologic changes after the formation of PUs. The expression of inflammatory cytokines was detected by qRT-PCR. And we detected the expression of protein by Western blotting. RESULTS Tryp could promote wound healing, such as epidermal thickening, revascularization, and nerve regeneration. Then the treatment of Tryp was able to promote fibroblast migration and collagen deposition. Moreover, Tryp attenuated inflammation through inducing macrophage polarization to M2 phenotype by suppressing the activation of cGAS-STING pathway. CONCLUSION Tryp could reduce the release of inflammatory cytokines, and induce RAW 264.7 polarization to M2 phenotype by targeting cGAS/STING/TBK1 pathways. In summary, Tryp may be a novel medicine for the treatment of PUs in the future.
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Affiliation(s)
- Yaozhi He
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Juanqing Yue
- (Department of Pathology) Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Yiwei Teng
- Renji College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ziwei Fan
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengxian Jia
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Honglin Teng
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linmin Zhuge
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Indraswari ADW, Aisyiyah U, Kurniawan K, Surboyo MDC. Prediction Pressure Ulcers in High Care Unit Patients: Evaluating Risk Factors and Predictive Scale Using a Prospective Cross-Sectional Study. Avicenna J Med 2024; 14:39-44. [PMID: 38694142 PMCID: PMC11057897 DOI: 10.1055/s-0043-1777420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background The incidence of ulcer pressure in the high care unit (HCU) was relatively high and could be reliably predicted using tools such as the Norton and Jackson/Cubbin scales. However, other risk factors, such as age, gender, consciousness, systemic condition, duration of treatment, and use of restraint, may contribute to the occurrence of ulcer pressure. This study was conducted to analyze the relationship of various risk factors for pressure ulcers and prediction of ulcer pressure, using Norton and Jackson/Cubbin scale, to incident pressure ulcers in HCU patient. Methods This study utilized a prospective cross-sectional study design to analyze various risk factors for ulcer pressure development in a patient admitted to the HCU, including age, gender, blood profile, consciousness, duration of treatment, and use of restraint. The Norton and Jackson/Cubbin scale was employed to predict pressure ulcers. The relationship between the risk factors and the prediction of pressure ulcer incidents was evaluated using multiple logistic binary regression analysis. Result Both the Norton and Jackson/Cubbin scales predicted a lower risk of pressure ulcer development (60.98 and 99.02%, respectively). This prediction is consistent with the low incidence of pressure injuries found, which is only 4.39%. Furthermore, the relationship between the identified risk factor (gender, duration of treatment in HCU and use of restraint) and the prediction and incident of pressure ulcer was not significant ( p > 0.05). Thus, it is suggested that these risk factors may not strong predictors of pressure ulcer development. Conclusion This study's result indicated no significant relationship exists between possible identified risk factors and the development of pressure ulcers in HCU patients. However, the Norton and Jackson/Cubbin scales were reliable predictors of pressure ulcer occurrence, with both scales predicting a lower risk of pressure ulcer development.
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Affiliation(s)
| | - Umi Aisyiyah
- Committee of Nursing, Fatmawati Hospital, Cilandak - South Jakarta, Indonesia
| | - Kurniawan Kurniawan
- Intensive Care Unit, Fatmawati Hospital, Cilandak – South Jakarta, Indonesia
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Blank J, Shiroff AM, Kaplan LJ. Surgical Emergencies in Patients with Significant Comorbid Diseases. Surg Clin North Am 2023; 103:1231-1251. [PMID: 37838465 DOI: 10.1016/j.suc.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and postoperative management. Providing goal concordant care is ideal using shared decision-making. When operation cannot achieve the patient's goal, non-operative therapy including Comfort Care is appropriate. When surgical therapy is offered, preoperative physiology-improving interventions are far fewer than in other phases. Reevaluation of clinical care progress helps define trajectory and inform goals of care. Palliative Care Medicine may be critical in supporting loved ones during a patient's critical illness. Outcome evaluation defines successful strategies and outline opportunities for improvement.
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Affiliation(s)
- Jacqueline Blank
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA
| | - Adam M Shiroff
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA; Surgical Services, Section of Surgical Critical Care and Emergency General Surgery, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Lewis J Kaplan
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA; Surgical Services, Section of Surgical Critical Care and Emergency General Surgery, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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14
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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McEvoy NL, Friel O, Clarke J, Browne E, Geoghegan P, Budri A, Avsar P, Connolly S, Patton D, Curley GF, Moore Z. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care 2023; 28:1115-1123. [PMID: 36221908 PMCID: PMC9875092 DOI: 10.1111/nicc.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.
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Affiliation(s)
- Natalie L. McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Oisin Friel
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Emmet Browne
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | | | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
| | - Gerard F. Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Beaumont HospitalDublinIreland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Health Sciences, Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Lida InstituteShanghaiChina
- Cardiff UniversityCardiffWalesUK
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Pérez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gómez-Arroyo JM, Sáez-Romero D, Ortiz-Monjo A. Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19. ENFERMERIA INTENSIVA 2023; 34:176-185. [PMID: 37248133 PMCID: PMC10201329 DOI: 10.1016/j.enfie.2022.12.001] [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: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 05/31/2023]
Abstract
The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.
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Affiliation(s)
- E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Comarcal de Manacor, Manacor, Spain; Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain.
| | - M Maqueda-Palau
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain; Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Spain
| | | | | | - D Sáez-Romero
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
| | - A Ortiz-Monjo
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
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Chen X, Liao P, Zhou Y. Construction of nursing-sensitive quality indicators for the care of patients with prone position ventilation using the Delphi method. BMC Nurs 2023; 22:336. [PMID: 37759252 PMCID: PMC10523608 DOI: 10.1186/s12912-023-01505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Prone position ventilation (PPV) has gradually become an adjuvant treatment to improve oxygenation in patients with acute respiratory distress syndrome. Scientific and comprehensive evaluation of the quality of nursing care for patients with PPV is of great significance to ensure the effectiveness of treatment and patient safety. However, there are no established objective indicators for evaluating the quality of nursing care for patients with PPV. This study intended to identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for the care of patients with PPV. METHODS Based on the Donabedian structure-process-result theory model, the quality evaluation indicators of nursing care for patients with PPV were preliminarily constructed based on an evidence-based perspective, and two rounds of Delphi surveys were conducted with the purpose of collecting opinions from a panel of independent experts. RESULTS The questionnaire recovery rates of the two rounds of correspondence were 100.00% and 95.00%, the recovery rates of expert opinions were 80.00% and 26.32%, the expert authority coefficient values were 0.89, and the Kendall coordination coefficient W values were 0.110 and 0.133, respectively. The final nursing-sensitive quality indicators for the care of patients with PPV included 3 first-level indicators, 9 s-level indicators and 29 third-level indicators. CONCLUSION The constructed nursing-sensitive quality indicators for the care of patients with PPV involve quality supervision during the whole process of PPV from three dimensions: structure, process and results. These indicators have strong operability, reliability, practicability and scientificity and can provide a reference for the quality evaluation and monitoring of nursing care for patients with PPV. IMPLICATIONS FOR NURSING MANAGEMENT The quality indicators of nursing care for patients with PPV constructed in this research are scientific and reliable, and the content of the quality indicators can better reflect the technical characteristics of special nursing. Nursing managers are encouraged to use these quality indicators to evaluate the quality of clinical nursing care and improve safety for patients with PPV.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Peng Liao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Desselle MR, Coyer F, Byram I, Fakhr R, Forrestal DP, Green N, Mason O, Wainwright L, Kirrane M. Safety and usability of proning pillows in intensive care: A scoping review. Aust Crit Care 2023; 36:847-854. [PMID: 37616086 DOI: 10.1016/j.aucc.2022.08.080] [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: 03/29/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Proning is an established technique for the care of intubated patients with severe respiratory failure. Positioning devices used to support the head and body of patients placed in the prone position are often associated with the formation of pressure injuries. Despite robust literature on the prevention and monitoring of pressure injuries, little is described about the role of proning pillows on pressure injuries. The objective of this review is to understand the extent of evidence pertaining to the safety and usability of different types of proning pillows in the intensive care setting. REVIEW METHOD A scoping review of the literature was completed using predefined search terms in three databases and identified 296 articles. An additional 26 were included from reference lists. Twenty studies are included in the analysis; most were published in the past 3 years, with >50% in surgical settings. DATA SOURCES Three databases were searched: PubMed, Scopus, and EMBASE. REVIEW METHODS The review followed the PRISMA Extension for Scoping Reviews, and data were reviewed using Covidence. RESULTS The most prevalent proning pillow is a standard, noncontoured foam head positioner. It is responsible for the majority of facial pressure injuries in all settings of care. Memory foam pillows and helmet-based systems offer improved surface pressure distribution, although their usability in the intensive care setting remains poorly studied. Inflatable air-cell-based devices present an alternative, but the lack of supporting research and the costs may explain their poor uptake. Several articles proposed the use of pressure sensor systems to evaluate devices. We propose a set of ergonomic parametres to consider when choosing or designing a positioning device for proned patients. CONCLUSION The evidence pertaining to the safety and usability of proning pillows in the intensive care setting is scarce, which provides opportunities for future research to improve the efficacy in the prevention of pressure injuries and the user experience.
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Affiliation(s)
- Mathilde R Desselle
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; Faculty of Engineering, Queensland University of Technology, Brisbane QLD 4000 Australia; School of Medicine, The University of Queensland, Herston QLD 4006 Australia.
| | - Fiona Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029 Australia; School of Nursing, Queensland University of Technology, Kelvin Grove QLD 4059 Australia
| | - Isabel Byram
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia
| | - Roozbeh Fakhr
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; Faculty of Creative Industries, Education and Social Justice, Queensland University of Technology, Kelvin Grove QLD 4059 Australia
| | - David P Forrestal
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia; School of Mechanical and Mining Engineering, The University of Queensland, St Lucia QLD 4067 Australia
| | - Nicholas Green
- Herston Biofabrication Institute, Metro North Health, Herston QLD 4029 Australia
| | - Oliver Mason
- Rehabilitation Engineering Centre, Surgical Treatment and Rehabilitation Services, Herston QLD 4029 Australia
| | - Luke Wainwright
- Clinical Skills Development Service, Herston QLD 4029 Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia QLD 4072 Australia
| | - Marianne Kirrane
- School of Medicine, The University of Queensland, Herston QLD 4006 Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029 Australia
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Chen X, Peng C, Xiao Y, Liu S. Construction and application of prone position ventilation management scheme for severe COVID-19 patients. Front Physiol 2023; 14:1152723. [PMID: 37693003 PMCID: PMC10488700 DOI: 10.3389/fphys.2023.1152723] [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: 01/28/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Prone position ventilation (PPV) can significantly improve oxygenation index and blood oxygen saturation in most (70%-80%) patients with acute respiratory distress syndrome. However, although PPV is not an invasive procedure, there are many potential PPV-related complications, such as nerve compression, crush injury, venous stasis (e.g., facial oedema), pressure sores, retinal damage, vomiting, and arrhythmia, with an incidence of up to 56.9%. Nursing managers have focused on reducing the occurrence of PPV-related complications and improving safety. Objective: To construct a prone ventilation management scheme for patients with severe coronavirus disease 2019 (COVID-19) and analyse its application effect. Methods: Based on a previous evidence-based study combined with the COVID-19 Diagnosis and Treatment Protocol (Trial Edition 9), a prone ventilation management protocol for severe COVID-19 was formulated and applied to COVID-19 patients in the intensive care unit of a designated hospital. A prospective self-control study was used to compare changes in the oxygenation index and other outcome indicators before and after the intervention. Results: The oxygenation index of patients after intervention (321.22 ± 19.77 mmHg) was significantly higher (p < 0.05) than before intervention (151.59 ± 35.49 mmHg). The difference in oxygenation index in different prone position ventilation durations was statistically significant (p < 0.05). Nursing quality evaluation indicators showed that the implementation rate of gastric residual volume assessment was 100% and the incidence of occupational exposure and cross-infection was 0%; the incidences of pressure ulcers, drug extravasation, and facial oedema were 13.64% (3/22), 4.54% (1/22), and 4.54% (1/22), respectively. The incidence of unplanned extubation, aspiration, and falls/falls was 0%.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Cao Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, China
| | - Yao Xiao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shiqing Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Lung Cancer Center, Central South University, Changsha, China
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Wang Z, Fan J, Chen L, Xie L, Huang L, Ruan Y, Xu X, Liang Z. Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study. Front Med (Lausanne) 2023; 10:1131270. [PMID: 37644983 PMCID: PMC10461099 DOI: 10.3389/fmed.2023.1131270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. Propose To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. Methods The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. Results After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. Conclusion According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.
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Affiliation(s)
- Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Jiangshan Fan
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Lingfang Huang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Yang Ruan
- Department of Outpatient, The 79th Hospital of Group Army, Liaoning, China
| | - Xia Xu
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Zeping Liang
- Department of Nursing, Daping Hospital, Chongqing, China
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Dolanová D, Búřilová P, Krupová L, Benešová K, Jarkovský J, Saibertová S, Pokorná A. Mortality related to pressure ulcers in Czech Republic - Analyses of national health registries. J Tissue Viability 2023:S0965-206X(23)00059-1. [PMID: 37198049 DOI: 10.1016/j.jtv.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
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.
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Affiliation(s)
- Dana Dolanová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Petra Búřilová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic; Department of Public Health, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic
| | - Lenka Krupová
- Department of Dermatology, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava, 708 00, Czech Republic
| | - Klára Benešová
- Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Jiří Jarkovský
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Simona Saibertová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic
| | - Andrea Pokorná
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic.
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22
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Sato L, Heck LO, Bimbatti KDF, Petroski-Moraes BC, Becari C, Basile-Filho A, Auxiliadora-Martins M, Gonçalves Menegueti M. Incidence of hospital acquired pressure injury in critically ill patients with COVID-19 in prone position admitted to the intensive care unit. Medicine (Baltimore) 2023; 102:e33615. [PMID: 37145003 PMCID: PMC10158435 DOI: 10.1097/md.0000000000033615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Critical patients have conditions that may favor the occurrence of hospital-acquired pressure injury (HAPI). The objective of this study was to identify the incidence and factors associated with the occurrence of HAPI in patients with coronavirus disease 2019 admitted to the intensive care unit (ICU) who used the prone position. Retrospective cohort study carried out in an ICU of a tertiary university hospital. Two hundred four patients with positive real-time polymerase chain reactions were evaluated, of which 84 were placed in the prone position. All patients were sedated and submitted to invasive mechanical ventilation. Of the prone patients, 52 (62%) developed some type of HAPI during hospitalization. The main place of occurrence of HAPI was the sacral region, followed by the gluteus and thorax. Of the patients who developed HAPI, 26 (50%) had this event in places possibly associated with the prone position. The factors associated with the occurrence of HAPI in patients prone to coronavirus disease 2019 were the Braden Scale and the length of stay in the ICU. The incidence of HAPI in prone patients was extremely high (62%), which denotes the need to implement protocols in order to prevent the occurrence of these events.
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Affiliation(s)
- Lucas Sato
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Bruno Cesar Petroski-Moraes
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Christiane Becari
- Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Auxiliadora-Martins
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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23
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DeMellow JM, Dhillon H, Bhattacharyya M, Pacitto D, Kozik TM. Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:197-202. [PMID: 37146109 DOI: 10.1097/won.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the incidence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) and placed in a prone position manually or using a specialty bed designed to facilitate prone positioning. A secondary aim was to compare mortality rates between these groups. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised 160 patients with ARDS managed by prone positioning. Their mean age was 61.08 years (SD = 12.73); 58% (n = 96) were male. The study setting was a 355-bed community hospital in the Western United States (Stockton, California). Data were collected from July 2019 to January 2021. METHODS Data from electronic medical records were retrospectively searched for the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the presence of a COVID-19 infection. RESULTS A majority of patients with ARDS were manually placed in a prone position (n = 106; 64.2%), and 54 of these patients (50.1%) were placed using a specialty care bed. Slightly more than half (n = 81; 50.1%) developed HAPIs. Chi-square analyses showed no association with the incidence of HAPIs using manual prone positioning versus the specialty bed (P = .9567). Analysis found no difference in HAPI occurrences between those with COVID-19 and patients without a coronavirus infection (P = .8462). Deep-tissue pressure injuries were the most common type of pressure injury. More patients (n = 85; 80.19%) who were manually placed in a prone position died compared to 58.18% of patients (n = 32) positioned using the specialty bed (P = .003). CONCLUSIONS No differences in HAPI rates were found when placing patients manually in a prone position versus positioning using a specialty bed designed for this purpose.
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Affiliation(s)
- Jacqueline M DeMellow
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Harbir Dhillon
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Mouchumi Bhattacharyya
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Daniel Pacitto
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Teri M Kozik
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
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24
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. YOLO-Based Deep Learning Model for Pressure Ulcer Detection and Classification. Healthcare (Basel) 2023; 11:healthcare11091222. [PMID: 37174764 PMCID: PMC10178524 DOI: 10.3390/healthcare11091222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Pressure ulcers are significant healthcare concerns affecting millions of people worldwide, particularly those with limited mobility. Early detection and classification of pressure ulcers are crucial in preventing their progression and reducing associated morbidity and mortality. In this work, we present a novel approach that uses YOLOv5, an advanced and robust object detection model, to detect and classify pressure ulcers into four stages and non-pressure ulcers. We also utilize data augmentation techniques to expand our dataset and strengthen the resilience of our model. Our approach shows promising results, achieving an overall mean average precision of 76.9% and class-specific mAP50 values ranging from 66% to 99.5%. Compared to previous studies that primarily utilize CNN-based algorithms, our approach provides a more efficient and accurate solution for the detection and classification of pressure ulcers. The successful implementation of our approach has the potential to improve the early detection and treatment of pressure ulcers, resulting in better patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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25
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Ruhland J, Dähnert E, Zilezinski M, Hauss A. Pressure Injury Prevention in Patients in Prone Position With Acute Respiratory Distress Syndrome and COVID-19. Crit Care Nurse 2023; 43:46-54. [PMID: 37001876 DOI: 10.4037/ccn2023559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introduction
In patients with acute respiratory distress syndrome, prone positioning improves oxygenation and reduces mortality. Pressure injuries occur frequently because of prolonged prone positioning in high-risk patients, and preventive measures are limited. This article describes 2 patients who developed minimal pressure injuries despite several prone positionings. Prevention strategies are also described.
Clinical Findings
A 64-year-old man and a 76-year-old woman were admitted to the hospital with respiratory insufficiency. Due to acute respiratory distress syndrome, both patients were intubated and received mechanical ventilation and prone positioning.
Diagnosis
Both patients had positive test results for SARS-CoV-2 and a diagnosis of acute respiratory distress syndrome.
Interventions
Patient 1 was in prone position for 137 hours during 9 rounds of prone positioning; patient 2, for 99 hours during 6 rounds of prone positioning. The standardized pressure injury prevention bundle for prone positioning consisted of skin care, nipple protection with a multilayer foam dressing, a 2-part prone positioning set, and micropositioning maneuvers. For both patients, 2-cm-thick mixed-porosity polyurethane foam was added between skin and positioning set in the thoracic and pelvic areas and a polyurethane foam cushion was added under the head.
Outcomes
Patient 1 developed no pressure injuries. Patient 2 developed category 2 pressure injuries on the chin and above the right eye during deviations from the protocol.
Conclusion
For both patients, the additional application of polyurethane foam was effective for preventing pressure injuries. These case reports support the addition of polyurethane foam to prevent pressure injuries in patients placed in the prone position.
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Affiliation(s)
- Julia Ruhland
- Julia Ruhland is a registered nurse in a COVID-19 intensive care unit, Department of Nephrology and Medical Intensive Care, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Germany
| | - Enrico Dähnert
- Enrico Dähnert is a registered nurse and practice development manager for nursing, Business Division Nursing Directorate, Nursing Science, Charité, Universitätsmedizin Berlin
| | - Max Zilezinski
- Max Zilezinski is a registered nurse and research associate, Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
| | - Armin Hauss
- Armin Hauss is a registered nurse, research associate, and quality improvement manager, Business Division Nursing Directorate, Nursing Science and Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
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26
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Pérez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gómez-Arroyo JM, Sáez-Romero D, Ortiz-Monjo A. [Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19]. ENFERMERIA INTENSIVA 2023; 34:S1130-2399(23)00019-6. [PMID: 37359191 PMCID: PMC10011029 DOI: 10.1016/j.enfi.2022.12.001] [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: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.
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Affiliation(s)
- E Pérez-Juan
- Unidad de Cuidados Intensivos. Hospital Comarcal de Manacor, Manacor, España
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, España
| | - M Maqueda-Palau
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, España
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, España
| | | | | | - D Sáez-Romero
- Unidad de Cuidados Intensivos, Hospital Son Llatzer, Palma, España
| | - A Ortiz-Monjo
- Unidad de Cuidados Intensivos, Hospital Son Llatzer, Palma, España
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27
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Man With an Anterior Chest Wall Ulcer. Ann Emerg Med 2023; 81:e49-e50. [PMID: 36813451 PMCID: PMC9939786 DOI: 10.1016/j.annemergmed.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 02/22/2023]
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28
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Aysal BK, Nisanci M. Single-session repair of multiple pressure ulcers in non-ambulatory patients. J Wound Care 2023; 32:109-115. [PMID: 36735526 DOI: 10.12968/jowc.2023.32.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pressure ulcers (PUs) are highly prevalent and challenging wounds. In this study, patients with either tetraplegia or paraplegia, all of whom had multiple grade 4 PUs and who underwent single-session surgical treatment were included. In order to increase the mobility of the musculocutaneous flap, the gluteus maximus muscle, which cannot be used by immobile patients, was detached and inserted into the flap. METHOD This was a retrospective case series and all PUs were reconstructed within the same surgical session. RESULTS A total of nine patients participated in the study, all of whom were male. Mean age was 33 years (range: 20-42 years). Mean follow-up period was 14.3 months (range: 9-24 months). All patients had a successful single-session repair of all PUs. Total or partial flap losses were not observed. Mean and total number of reconstructed PUs were 2.55 and 23, respectively. The mean area of reconstructed open wounds per patient was 174.6cm2 and the mean operation duration was 253 minutes. The level of blood loss was acceptable as the decrease in haemoglobin levels was not more than 2g/dl for each patient. CONCLUSION Multiple PUs can be repaired in one session using gluteus maximus musculocutaneous flaps in immobile patients. Based on the fact that the gluteus maximus is an essential muscle for ambulation, our approach can only be used in the treatment of patients with irreversible paraplegia or tetraplegia. When all prerequsities are met, the amount of blood loss and operation duration are acceptable, and returning the patient to a wound-free state can be achieved more quickly compared to multi-session repairs. Air-fluidised beds are vital tools for accomplishing single session repairs of multiple PUs. The data shows that the approach is safe and can be used in patients with multiple PUs.
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Affiliation(s)
- Bilge Kagan Aysal
- Mugla Sitki Kocman University, Department of Plastic, Reconstructive and Aesthetic Surgery, Mugla, Turkey
| | - Mustafa Nisanci
- Mugla Sitki Kocman University, Department of Plastic, Reconstructive and Aesthetic Surgery, Mugla, Turkey
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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30
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Rubio-Gil FJ, Ruiz-Antúnez E, Nieto-García A, Alonso-Sardón M. Is the Increase in Record of Skin Wounds in Hospitalized Patients in Internal Medicine Units a Side Effect of the COVID-19 Pandemic? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2228. [PMID: 36767595 PMCID: PMC9916326 DOI: 10.3390/ijerph20032228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Wound care is an important public health challenge that is present in all areas of the healthcare system, whether in hospitals, long term care institutions or in the community. We aimed to quantify the number of skin wounds reported after and during the COVID-19 pandemic. This descriptive longitudinal retrospective study compared of wound records in patients hospitalized in the internal medicine service during the first year of the COVID-19 pandemic (from 1 March 2020, to 28 February 2021) and previous-year to the outbreak (from 1 January 2019, to 31 December 2019). A sample of 1979 episodes was collected corresponding to 932 inpatients, 434 from the pre-pandemic year and 498 from the first year of COVID-19 pandemic; 147 inpatients were diagnosed with SARS-CoV-2 infection (3.2%). The percentage of wound episodes in the first year of the COVID-19 pandemic was higher than the pre-pandemic year, 17.9% (1092/6090) versus 15% (887/5906), with a significant increase in the months with the highest incidence of COVID cases. This study shows an increase in the burden of wound care during the COVID-19 pandemic, and it could be attributable to the increase in the number of patients hospitalized for SARS-CoV-2 infection in internal medicine units.
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Affiliation(s)
- Leticia Nieto-García
- School of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Adela Carpio-Pérez
- Internal Medicine Service, Institute for Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, 37007 Salamanca, Spain
| | | | | | - Emilia Ruiz-Antúnez
- Training, Development and Innovation Area, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Ainhoa Nieto-García
- School of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Preventive Medicine, Epidemiology and Public Health Area, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, 37007 Salamanca, Spain
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31
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Yang F, Shen C. Sodium Danshensu Cream Promotes the Healing of Pressure Ulcers in Mice through the Nrf2/HO-1 and NF-κB Pathways. Pharmaceuticals (Basel) 2022; 15:ph15121548. [PMID: 36558999 PMCID: PMC9783848 DOI: 10.3390/ph15121548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
On the basis of the mice pressure ulcers (PU) model, the protective effect and potential mechanism of sodium Danshensu (SDSS) cream against PU were investigated. The mice were randomly divided into three groups: the negative control group (cream without 0.5 g SDSS), the SDSS group (cream containing 0.5 g SDSS), and the positive group (0.5 g Hirudoid®). After 7 and 14 days of ointment application, the wound-healing rate of the SDSS and positive groups was significantly higher than that of the control group (p < 0.05). The results of hematoxylin−eosin staining also indicated that SDSS has the potential to promote the healing of PU. In addition, the serum IL-6, IL-1β, TNF-α, and MDA levels decreased significantly (p < 0.01) after 14 days of SDSS treatment, while the SOD, CAT, and GSH-Px activities increased significantly (p < 0.01). In addition, SDSS cream was able to significantly increase the expression of Nrf2, HO-1, GCLM, NQO1, NF-κB p65, NF-κB p50, IKKα, and IKKβ while decreasing the expression of Keap1 and IκBαin the Nrf2/HO-1 and NF-κB pathways. Our research will provide a foundation for the future clinical prevention and treatment of PU with SDSS cream.
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Affiliation(s)
- Fei Yang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China
- Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, China
| | - Cuizhen Shen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China
- Correspondence:
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32
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Patton D, Latimer S, Avsar P, Walker RM, Moore Z, Gillespie BM, O'Connor T, Nugent L, Budri A, Brien NO, Chaboyer W. The effect of prone positioning on pressure injury incidence in adult intensive care unit patients: A meta-review of systematic reviews. Aust Crit Care 2022; 35:714-722. [PMID: 34916149 DOI: 10.1016/j.aucc.2021.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Numerous systematic reviews have examined the impact of prone positioning on outcomes, including pressure injury (PI). The objective of this meta-review was to synthesise the evidence on the effect of prone positioning on the incidence and location of PIs in adult intensive care unit patients. REVIEW METHOD This is a meta-review of published systematic reviews. Five databases were searched; data were extracted by three authors and adjudicated by a fourth. The AMSTAR-2 tool was used to quality appraise the selected articles, which was completed by three authors with a fourth adjudicating. RESULTS Ten systematic reviews were synthesised. The cumulative incidence of PI in 15,979 adult patients ranged from 25.7% to 48.5%. One study did not report adult numbers. Only one review reported the secondary outcome of PI location. PIs were identified in 13 locations such as the face, chest, iliac crest, and knees. Using the AMSTAR-2, three reviews were assessed as high quality, six as moderate quality, and one as low quality. CONCLUSION The high incidence of PI in the prone position highlights the need for targeted preventative strategies. Care bundles may be one approach, given their beneficial effects for the prevention of PI in other populations. This review highlights the need for proactive approaches to limit unintended consequences of the use of the prone position, especially notable in the current COVID-19 pandemic.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Faculty of Science, Medicine and Health, University of Wollongong, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Linda Nugent
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.
| | - Aglecia Budri
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Niall O Brien
- Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Griffith University, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
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Kandi LA, Rangel IC, Movtchan NV, Van Spronsen NR, Kruger EA. Comprehensive Management of Pressure Injury. Phys Med Rehabil Clin N Am 2022; 33:773-787. [DOI: 10.1016/j.pmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seckel MA, Mitchell DA. Securing Endotracheal Tubes During Prone Positioning. Crit Care Nurse 2022; 42:77-79. [PMID: 36180052 DOI: 10.4037/ccn2022354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Maureen A Seckel
- Maureen A. Seckel is a critical care clinical nurse specialist and sepsis coordinator, ChristianaCare, Newark, Delaware
| | - Dannette A Mitchell
- Dannette A. Mitchell is a medical critical care clinical nurse specialist, ChristianaCare, Wilmington, Delaware
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Dantas AC, Costa ML, Silva ABD, Borges BEC, Araújo JNDM, Vitor AF. Eye Care Interventions in Critical/Surgical Patients in the Prone Position: Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study aimed to map evidence of eye care interventions in managing critical or surgical patients submitted to prone positions. Materials and method: This scoping review was prepared according to the Joanna Briggs Institute’s methodology, following the PRISMA-ScR criteria. A search was conducted from July to August 2020 in the SCOPUS, Web of Science, Science Direct, PubMed Central, CINAHL, and COCHRANE databases. The following research question was delimited: “What are the strategies and interventions used for eye care in the management of critical patients or surgical patients submitted to the prone position?” The sample consisted of 24 studies after applying the inclusion and exclusion criteria. Results: Eye care interventions in managing critical/surgical patients submitted to the prone position were eye examination, use of lubricants/specific ophthalmic solution, reverse Trendelenburg positioning, and protection with adhesive tape. Conclusions: This review allowed the understanding of eye care for critical/surgical patients in a prone position. Among the care presented, a large part is related to nursing since it is closer to patient care. The findings emphasize the need to implement patient safety policies with eye care as a priority.
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36
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Rohée-Traoré A, Kün-Darbois JD, Boucher S. Masseter muscle pressure injury: First report of a prone position complication in patients with COVID-19. Intensive Crit Care Nurs 2022; 71:103251. [PMID: 35396096 PMCID: PMC8940568 DOI: 10.1016/j.iccn.2022.103251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
We report the case of a 59-year-old, obese woman who underwent prolonged prone position during the medical management of an acute respiratory distress syndrome induced by SARS-CoV-2 infection, complicated by a masseter muscle pressure injury. Such side effect may be underestimate in intensive care units and should be prevent by prophylactic dressings on facial weight-bearing sites. The understanding of facial deep tissue injury is essential to guide clinical detection and management of such a complication in COVID-19 patients.
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Affiliation(s)
- Adèle Rohée-Traoré
- Department of Maxillofacial Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France.
| | - Jean-Daniel Kün-Darbois
- Department of Maxillofacial Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France; Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045 ANGERS Cedex 01, France
| | - Sophie Boucher
- Department of ENT and Head and Neck Surgery, Angers University Hospital, 4 rue Larrey, 49933 ANGERS Cedex, France; MitoLab team, MitoVasc Institute, CNRS UMR6015, INSERM U1083, 49933 ANGERS Cedex 09, France
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Alderden J, Kennerly SM, Cox J, Yap TL. Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Adv Crit Care 2022; 33:173-185. [PMID: 35657764 DOI: 10.4037/aacnacc2022335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
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Affiliation(s)
- Jenny Alderden
- Jenny Alderden is Associate Professor, Boise State University School of Nursing, 1910 University Dr, Boise, ID 83725
| | - Susan M Kennerly
- Susan M. Kennerly is Professor, East Carolina University College of Nursing, Greenville, North Carolina
| | - Jill Cox
- Jill Cox is Clinical Associate Professor, Rutgers University, and Wound, Ostomy, Continence Advanced Practice Nurse, Englewood Health, Newark, New Jersey
| | - Tracey L Yap
- Tracey L. Yap is Associate Professor, Duke University School of Nursing, Durham, North Carolina
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Ludwig VU, Pickenbrock H, Döppner DA. Factors Facilitating and Hindering the Use of Newly Acquired Positioning Skills in Clinical Practice: A Longitudinal Survey. Front Med (Lausanne) 2022; 9:863257. [PMID: 35602507 PMCID: PMC9118333 DOI: 10.3389/fmed.2022.863257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background After learning new skills, healthcare professionals do not always apply them in practice, despite being motivated. This may be referred to as an intention-behavior gap. One example is the positioning of immobilized and disabled patients in hospitals, nursing homes, or neurorehabilitation clinics. Positioning is crucial to prevent complications such as pressure sores, pneumonia, and deep vein thrombosis. However, it is often not carried out optimally even when professionals have completed education programs. The LiN-method is a positioning procedure involving a special focus on aligning and stabilizing body parts, which has been shown to have advantages over conventional positioning. We assess which factors may facilitate or hinder the use of LiN in clinical practice after participants complete training. Methods A longitudinal survey with 101 LiN-course participants was conducted in Germany. Each participant completed a questionnaire directly after the course and 12 weeks later, including a report of the frequency of use in practice. They also completed a questionnaire which surveyed 23 aspects that might facilitate or hinder use of the new skills, covering the workplace, socio-collegial factors, motivation, self-confidence, and mindset. Results Most assessed aspects were associated with LiN-use, with the highest correlations found for confidence with the method, perceived ease of application, sufficient time, assessing one's skills as sufficient, remembering the relevant steps, and a work environment open to advanced therapeutic concepts. To reduce data complexity, the questionnaire was subjected to a factor analysis, revealing six factors. A regression analysis showed that four factors predicted use 12 weeks after course completion, in the following order of importance: (1) subjective aspects/confidence, (2) access to materials, (3) work context, and (4) competent support in the workplace. Conclusion Numerous aspects are associated with the use of recently acquired clinical or nursing skills, such as LiN. Many of these can be improved by appropriately setting up the workplace. The aspects most associated with use, however, are confidence with the method and self-perceived competence of healthcare professionals. While causality still needs to be demonstrated, this suggests that education programs should support participants in developing confidence and foster a mindset of continuous learning.
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Affiliation(s)
- Vera U Ludwig
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Wharton Neuroscience Initiative, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Daniel A Döppner
- Department of Information Systems and Information Management, University of Cologne, Cologne, Germany
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, Fallahi M. Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J 2022; 19:2039-2054. [PMID: 35322547 PMCID: PMC9111574 DOI: 10.1111/iwj.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.
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Affiliation(s)
- Mahin Amini
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Vafaee
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Mahdavikian
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences Sciences, Kermanshah, Iran
| | - Yasaman Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Fallahi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zanchetta FC, Silva JLG, Pedrosa RBDS, Oliveira-Kumakura ARDS, Gasparino RC, Perissoto S, Silva VA, Lima MHDM. Cuidados de enfermagem e posição prona: revisão integrativa. AVANCES EN ENFERMERÍA 2022. [DOI: 10.15446/av.enferm.v40n1supl.91372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objetivo: explorar, na literatura científica, práticas atuais de cuidado de enfermagem ou intervenções para pacientes com síndrome respiratório agudo grave (SRAG) submetidos à posição prona.
Síntese do conteúdo: revisão integrativa, na qual foram realizadas buscas nas bases de dados PubMed, CINAHL, Scopus, Web of Science e LILACS em setembro de 2020 e janeiro de 2022, sem recorte temporal, por meio da questão deste estudo: “Quais são os cuidados de enfermagem para pacientes com SRAG submetidos à posição prona?”. Foram selecionados 15 artigos, a partir da busca nas bases de dados. Após a leitura, os cuidados encontrados foram categorizados em alinhamento do corpo para a prevenção de lesões neuromusculares, cuidados com equipamentos diversos, cuidados tegumentares e recomendações neurológicas.
Conclusões: o enfermeiro deve ter conhecimento sobre as implicações e as complicações de se manter um paciente na posição prona. Tal conhecimento permitirá tomadas de decisões na construção ou no seguimento de protocolos institucionais que contribuam com a prevenção de riscos e resultem em melhores desfechos para o paciente.
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Madueño JM, Sayer L. Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S22-S32. [PMID: 35220748 DOI: 10.12968/bjon.2022.31.4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Many patients with COVID-19 admitted to intensive care undergo prone positioning. These patients are at risk of developing facial pressure ulcers (PUs). This study aimed to identify evidence-based recommendations to prevent or reduce their incidence. METHOD A multi-case study was undertaken using secondary data published between November 2020 and April 2021 discussing facial PUs in patients with COVID-19. CINAHL and MEDLINE electronic databases were analysed. Sixteen publications met the inclusion criteria. The overall quality of evidence was low. RESULT Studies reported a high incidence of facial PUs. The evidence suggests key preventive areas are skin assessment, pressure-redistribution surfaces, eye coverings, education, medical devices and prophylactic dressings. Recommendations included skin cleaning and moisturising, eye coverings, replacing endotracheal tube holders and using hydrocolloid or film dressings. CONCLUSION Considering the severe implications for patients and healthcare systems caused by facial PUs, ICUs should develop strategies to prevent and minimise them.
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Affiliation(s)
- Jaime Moreno Madueño
- Registered Nurse, at time of writing studying MSc Nursing with Registration as an Adult Nurse, King's College London
| | - Lynn Sayer
- Senior Lecturer, Department of Adult Nursing, King's College London
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Soldera D, Soares CF, Girondi JBR, Salum NC, Stein M, Amante LN, Sebold LF, Miranda GM. PREVENÇÃO DE LESÕES POR PRESSÃO NA PRONAÇÃO DE PACIENTES COVID-19: CONSTRUÇÃO DE UMA NARRATIVA GRÁFICA. ESTIMA 2022. [DOI: 10.30886/estima.v19.1136_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:construir e validar o conteúdo de uma narrativa gráfica sobre a prevenção de Lesão por Pressão na posição prona em pacientes acometidos pelo Coronavírus. Método: estudo metodológico descritivo. Para a construção da narrativa gráfica, foi realizada a revisão de escopo. A validação de conteúdo da narrativa foi realizada por enfermeiros atuantes em unidades de terapia intensiva respiratória estomaterapeutas de Santa Catarina, os quais responderam a um formulário no Googleforms® com opções de resposta de discordo a concordo. A análise de dados foi realizada por meio do Índice de Validade de Conteúdo, considerando adequado > 0,80%. Resultados: os cuidados elencados para compor a narrativa foram: avaliação da pele; manutenção da pele limpa e hidratada; utilização de dispositivos de redistribuição de pressão; utilização de espumas de silicone, filmes transparentes, spray formador de barreira e silicone sobre as proeminências ósseas, sob dispositivos médicos e em face. A posição recomendada é a do nadador, reposicionando o paciente a cada duas horas. Conclusão: a narrativa gráfica foi validada para enfermeiros experts cujo destaque está para os cuidados preventivos no sentido de promover o engajamento da equipe de Enfermagem frente à importância da prevenção da Lesão por Pressão no cuidado ao paciente com Coronavírus e pronado.
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Soldera D, Soares CF, Girondi JBR, Salum NC, Stein M, Amante LN, Sebold LF, Miranda GM. PREVENTION OF PRESSURE INJURIES IN THE PRONATION OF COVID-19 PATIENTS: CONSTRUCTION OF A GRAPHIC NARRATIVE. ESTIMA 2022. [DOI: 10.30886/estima.v19.1136_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective:build and validate the content of a graphic narrative on the prevention of Pressure Injury in the prone position in patients affected by the Coronavirus. Method: descriptive methodological study. For the construction of the graphic narrative, a scope review was carried out. Narrative content validation was performed by nurses working in stomatherapists in respiratory intensive care units in Santa Catarina, who responded to a form on Googleforms® with response options from disagree to agree. Data analysis was performed using the Content Validity Index, considering appropriate > 0.80%. Results: the care listed to compose the narrative were: skin assessment; keeping the skin clean and hydrated; use of pressure redistribution devices; use of silicone foams, transparent films, barrier-forming spray and silicone on bony prominences, under medical devices and on the face. The recommended position is that of the swimmer, repositioning the patient every two hours. Conclusion: the graphic narrative was valid for expert nurses whose emphasis is on preventive care in order to promote the engagement of the Nursing team in the face of the importance of Pressure Injury prevention in the care of patients with Coronavirus and prone.
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Fagotti de Almeida CE, Cirino Dos Santos APB, Biaziolo CFB, Mateus de Vasconcelos ECL, Oliveira FV, Jorge JLG, Ferreira MC, Coltro PS, Junior JAF. The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region. J Wound Care 2022; 31:92-98. [PMID: 35077205 DOI: 10.12968/jowc.2022.31.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation-direct cell deformation, inflammatory oedema and ischaemic damage-which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery. METHOD Patients with deep PI in the pelvic region, who were operated on from 2011 to 2019, were retrospectively evaluated. The protocol of care included training in the prone position, followed by maintenance of the prone position for 4-6 weeks postoperatively. The reconstruction was performed with fasciocutaneous and myocutaneous local or regional flaps. RESULTS The study evaluated a total of 26 patients. The rate of recurrence of PIs was 15.4% (4/26) in the mean follow-up of 54 months. Regarding postoperative complications, four cases of partial dehiscence of the suture occurred. CONCLUSION This perioperative protocol of maintaining a prone position seems to be safe for the patient, and it can be used to prevent or reduce the recurrence of deep PIs on the pelvic region after reconstructive surgery.
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Affiliation(s)
| | | | | | | | | | - João Luís Gil Jorge
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Marcus Castro Ferreira
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Pedro Soler Coltro
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Iblasi AS, Aungsuroch Y, Gunawan J, Gede Juanamasta I, Carver C. Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis. SAGE Open Nurs 2022; 8:23779608221106443. [PMID: 35720208 PMCID: PMC9201313 DOI: 10.1177/23779608221106443] [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: 01/08/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Repositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes. Objective To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis. Concept Description Repositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences. Discussion Repositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications. Conclusion Repositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.
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Affiliation(s)
| | | | - Joko Gunawan
- Faculty of Nursing, Chulalongkorn University Bangkok, Thailand
| | - I. Gede Juanamasta
- Faculty of Nursing, Chulalongkorn University Bangkok, Thailand
- Nursing Program, STIKes Wira Medika Bali, Denpasar, Bali, Indonesia
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Gasmi Benahmed A, Gasmi A, Anzar W, Arshad M, Bjørklund G. Improving safety in dental practices during the COVID-19 pandemic. HEALTH AND TECHNOLOGY 2022; 12:205-214. [PMID: 35036281 PMCID: PMC8743069 DOI: 10.1007/s12553-021-00627-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/18/2021] [Indexed: 01/11/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It originated from the Chinese city of Wuhan and very quickly became a challenging public health problem. On 11 March 2020, the World Health Organization termed this potentially deadly disease a pandemic due to its rapid spread in various parts of the world, giving rise to international health emergencies. This virus is transmitted from human to human in the form of respiratory droplets, and in specific circumstances, airborne transmission may occur. Additional sources of exposure for dentists include blood and infected sharps. Due to the contagious nature of COVID-19 many health care providers have also been disproportionately affected, such as physicians, dentists, nurses, and paramedical staff. Dentists and dental staff are at high risk of cross-infection due to their nature of work. Therefore, they face a dual challenge in protecting themselves and their patients from infection transmission while ensuring that patients receive urgent dental care. In this review, the authors highlight the epidemiology, modes of cross-infection, and recent data on SARS-CoV-2 related to dental practice. The primary purpose is to make dental health care providers aware of the pathophysiology of COVID-19 and to increase their preparedness and understanding of this challenge, which will aid in controlling transmission. The information collected will be useful for the dental community in providing effective patient management through evidence-based recommendations for infection control and disinfection protocols.
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Affiliation(s)
| | - Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Wajiha Anzar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Mehreen Arshad
- National University of Sciences and Technology, Islamabad, Pakistan
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
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Campos HH, Vásquez AI, Mazzachiodi LR, de Gouveia Santos VLC. Desafíos en el cuidado de personas con Covid-19 en posición prono: apoyo al estudio internacional PRONEtect. J Wound Care 2022; 31:6-9. [PMID: 36789922 DOI: 10.12968/jowc.2022.31.latam_sup_5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Sinopsis: El siguiente editorial presenta los resultados de una encuesta a los líderes de las 13 asociaciones de la Confederación Multidisciplinar Latinoamericana de Heridas, Estomas e Incontinencias (COMLHEI). La encuesta buscó determinar, de manera general, la situación de los pacientes con Covid-19 en posición prono (PP) con desarrollo de lesiones por presión (LPP). Los resultados indican que, en América latina, las LPP en pacientes en PP son frecuentes. Se evidenciaron deficiencias en estudios epidemiológicos y de elementos de protección, prevención y educación, además de brechas entre los diferentes países e instituciones en cuanto a la disponibilidad de personal para poder cumplir con las recomendaciones de posicionamiento de los pacientes. Las autoras sugieren tener en cuenta los resultados del estudio internacional PRONEtect para identificar, revisar y evaluar las pautas internacionales de pronación y cuidado de la piel, y hacer un inventario de los equipos y recursos de capacitación de uso común.
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Forni C, Gazineo D, Allegrini E, Bolgeo T, Brugnolli A, Canzan F, Chiari P, Evangelista A, Grugnetti AM, Grugnetti G, Guberti M, Matarese M, Mezzalira E, Pierboni L, Prosperi L, Sofritti B, Tovazzi C, Vincenzi S, Zambiasi P, Zoffoli C, Ambrosi E, Bandi F, Batani M, Bertin G, Bianchi L, Carmagnini M, Cedioli S, Colognese S, Consuelo M, D'Alessandro F, Fontana M, Galassi L, Gridelli M, Magnani P, Morri M, Ortolani B, Scialla M, Stanga P, Toselli P, Zanelli S. Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: randomized controlled trial. Int J Nurs Stud 2022; 127:104172. [DOI: 10.1016/j.ijnurstu.2022.104172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
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