Highly cited papers in critical care nursing can offer valuable insights for all stakeholders engaged in the research process by highlighting key research trends, guiding resource allocation and shaping future research priorities.

To gain insights from the top-cited papers in the top critical care nursing journals.

This was a bibliometric analysis of the top-cited papers in the top critical care nursing journals as reported by the Journal Citation Report 2023-released in June 2024. Data were tabulated and visualized using Microsoft Excel and the VOSviewer software.

Forty papers from the top four critical care nursing journals (Intensive and Critical Care Nursing [ICCN], Nursing in Critical Care [NICC], Australian Critical Care [ACC] and American Journal of Critical Care [AJCC]) were analysed. Half of the analysed papers were related to the COVID-19 pandemic, and mental health was the most addressed theme (n = 11 papers). Papers from the ICCN featured contributions from 17 countries, the highest among the journals analysed, followed by NICC, with contributions from 11 countries. Articles received more citations than reviews (median [interquartile range]: 18 [9-23] vs. 8 [8-11.5]), and open-access papers were cited about twice those published under a subscription model (19 [16-31] vs. 9 [8-15]). In ICCN, 9 of the 10 analysed papers were published open access compared with 3 in NICC and ACC and 2 in AJCC.

The identified themes in this paper underscore the dynamic nature of the field of critical care nursing and the ongoing efforts to address key challenges in critical care nursing practice and health care delivery. Publishing open-access articles on trending topics and collaborating internationally seem to be effective approaches for gaining more citations.

Understanding these prevalent themes has significant implications for guiding research priorities, informing clinical practice, shaping policy and improving patient outcomes. Academic journals need to encourage increasing the representation of researchers from the Global South in both journals' editorial boards and submissions to the journals.

To explore the relationship between the Geriatric Nutritional Risk Index (GNRI) and the occurrence of Pressure injury (PI) in elderly Intensive Care Unit (ICU) patients.

PI represent a significant health concern within ICU, where the occurrence of such injuries is notably high among critically ill patients. However, few studies have explored the relationship between GNRI and PI.

A longitudinal, single-centre, retrospective study.

The study utilised GNRI calculation to identify PI occurrences. A comprehensive set of covariates was analysed, including demographic information, severity of illness scores, comorbidities, therapeutic interventions, vital signs and laboratory values. Statistical analysis involved descriptive statistics, logistic regression and receiver operating characteristic curves, supplemented by a doubly robust estimation method and propensity score modelling. This study follows the STROBE-nut checklist.

Among 5327 critically ill patients enrolled in the study, with a median age of 76 years, of which 2339 were females, representing 43.91% of the total study population. Binary logistic regression analysis revealed that with each unit increase in the GNRI, the likelihood of PI occurrence decreased by 3.7% in the fully adjusted model. Furthermore, there was a significant decrease in PI occurrence among patients deemed to have no risk compared to those identified as at-risk.

GNRI emerges as a significant, independent predictor of PI risk in elderly ICU patients, underscoring the importance of nutritional assessment and management in this population.

This study highlights the critical importance of nutritional assessment, specifically through GNRI, in early identification and prevention of pressure injuries among elderly ICU patients, underscoring the need for integrated nutritional strategies in clinical settings.

This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study.

Pressure injuries (PIs) remain a significant public health concern due to their high prevalence among critically ill patients admitted to intensive care units (ICUs). Despite advancements in science and technology related to PI prevention, the prevalence continues to rise. A key factor contributing to this rise is inadequate knowledge and limited use of evidence-based practices by nurses, resulting in prolonged hospital stays and poor patient outcomes. This study aimed to determine the knowledge of intensive care nurses regarding pressure injury prevention.

A descriptive cross-sectional design was used to collect data from 101 nurses working in four ICUs at an academic hospital in Gauteng Province, South Africa. The revised Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0) was utilized to gather data from a convenience sample of intensive care nurses. Descriptive and inferential statistics were employed to analyze the data, with statistical tests including the Shapiro-Wilk test, univariate and multivariate linear regression, and Cronbach's alpha coefficient tests. A p-value of less than 0.05 was considered statistically significant.

The mean knowledge score of the nurses (N = 101) was 42.16% (SD 12.09), indicating poor knowledge of PI prevention. The lowest scores were observed in the areas of "prevention of pressure injuries" (25%) and "classification and observation" (39.5%). Higher levels of education (14.00; 95% CI 2.90-25.11; p = 0.014), seniority (15.58; 95% CI 2.92-28.24; p = 0.016), and years of experience (6.38; 95% CI 9.70-5.45; p = 0.039) were statistically significant predictors of better prevention and management of PI.

The findings of this study demonstrate that intensive care nurses have poor knowledge of prevention measures, classification, and observation of stages. This may hinder their ability to effectively utilize risk assessment tools in clinical practice. Improving training and providing intensive care nurses with adequate information about evidence-based practices to prevent PI could strengthen their contribution to patient safety. These findings underscore the need for continuous, mandatory training programs for intensive care nurses to stay updated with the latest evidence and practices in PI prevention.

Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care-specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions.

The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions.

A controlled before-after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence.

The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%-100%), but the all-or-nothing compliance was poor (33%).

Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.

Pressure Injuries are a prevalent and concerning issue in critical care settings, impacting patient well-being and healthcare systems.

Measure the point prevalence of acquired pressure injuries in Omani critical care units and assess the adequacy of preventive measures.

A multicenter cross-sectional survey was conducted in four major Omani hospitals, encompassing various geographical regions and health sectors. A convenient sample of 156 adult patients in critical care units was examined using the European Pressure Ulcer Advisory Panel methodology. Data on prevalence, risk assessment, and prevention measures were collected and analyzed.

The study revealed a prevalence rate of 21.8 % for hospital-acquired pressure injuries (including stage I) and 19.2 % (excluding stage I) in Omani critical care units. The sacrum was the most affected area, with stage II being predominant. Alarmingly, some at-risk patients did not receive appropriate preventive equipment, while low-risk patients received unnecessary measures. Approximately 73.3 % of at-risk patients received adequate prevention.

This pioneering study in Oman addresses the prevalence of Pressure Injuries, revealing rates that are higher than international norms. Additionally, the research underscores deficiencies in preventive measures, such as inadequate prevention for at-risk patients and unnecessary measures for low-risk individuals.

Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs.

The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay.

This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories.

Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points).

The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness.

Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.

To perform the cross-cultural adaptation of CALCULATE for Brazilian Portuguese.

A methodological study conducted from January to December 2021, divided into six stages: translation, synthesis, back-translation, expert committee with the application of the content validity index, pre-testing in 40 adult patients, and submission to the authors. The study took place in the intensive care units of a public tertiary teaching hospital in the interior of the state of São Paulo, Brazil. The original CALCULATE has eight risk assessment items and is stratified with a score of 0-3 (high risk) and 4-8 (very high risk).

After expert evaluation, the final content validity was 0.9. They suggested words and phrases that should undergo changes regarding textual equivalences, as well as definitions of acronyms and terminologies. In the pre-test, the items were assessed as suitable for understanding; only one item required additional explanation for adequacy.

The cross-cultural adaptation of CALCULATE for Brazilian Portuguese was successfully performed, revealing a good content validity index, confirming the relevance and appropriateness of its items. CALCULATE is suitable for use in intensive care units and research and teaching centers.

Patients in neurology intensive care units (ICU) are prone to pressure injuries (PU) due to factors such as severe illness, long-term bed rest, and physiological dysfunction. PU not only causes pain and complications to patients, but also increases medical burden, prolongs hospitalization time, and affects the recovery process.

To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.

A retrospective study was conducted, and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission, with 30 people in each group. The observation group implemented pressure injury prevention and nursing measures, while the control group adopted routine care.

Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h (8.3% vs 26.7%), 7 d (16.7% vs 43.3%), and 14 d (20.0% vs 50.0%). This suggests a substantial reduction in pressure injury incidence in the observation group, with the gap widening over time. Additionally, patients in the observation group exhibited quicker recovery, with a shorter average time to get out of bed (48 h vs 72 h) and a shorter average length of stay (12 d vs 15 d) compared to the control group. Furthermore, post-intervention, patients in the observation group reported significantly improved quality of life scores, including higher scores in body satisfaction, feeling and function, and comfort (both psychological and physiological), indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.

Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.

Exploratory.

Scoping review.

Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).

Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).

Quality of evidence was low for the interventional studies and best practice recommendations.

Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.

This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.

We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.

Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).

To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units.

Four intensive care units in a Norwegian University Hospital.

A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals.

The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]).

The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable.

Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19.

A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement.

A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage.

PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures.

The authors have no conflicts of interest to declare.

This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated.

Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included.

Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy.

The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.

To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field.

Descriptive and bibliometric analysis method study.

Data were obtained from the "Web of Science Core Collection" database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords "intensive care unit," "pressure injury," "prevention," "risk assessment tools," and critical care." Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications.

Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools.

As a result of the analysis, the most used keywords were "pressure injury," "pressure ulcer," "critical care," "pressure ulcers," "intensive care unit," and "pressure injuries." The journal with the highest number of publications (n = 55) was "Journal of Wound Ostomy Continence Nursing", the highest number of articles (n = 47) was published in 2022, the most active institution was "Queensland University of Technology Qut" (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the "National Institutes of Health NIH USA" (20 articles), and Cox J. was the author who published the most articles.

This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units.

The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.

To explore pressure injury prevention practices and evaluate the impact of an educational intervention on PI prevalence before and after an educational intervention.

A multi-centre observational study.

Data were collected at two time points in May 2021 and April 2022 using a Qualtrics® online form. Two Registered Nurses at each site collected observational data at each time point by diagnosing and staging any identified pressure injuries as part of a prevalence study. Patients admitted to participating units were included.

A total of 181 patients in critical care units were included at the two-time points. Pressure injury prevalence was 60.9% at the outset, with 52.9% hospital-acquired, 37.9% unit-acquired and 23.0% medical device-related. Post-intervention prevalence decreased significantly to 28.7%, including 21.3% hospital-acquired, 14.9% unit-acquired, and 8.5% medical device-related. Pressure injuries were prominent in the sacral region, head area, and heels. Stages I and II pressure injuries were the most common. Increased age and longer ICU stays are linked to a heightened risk of pressure injury development in critically ill patients, whereas higher haemoglobin levels show an inverse relationship with the development of both pressure injury and severe stages in the univariate analysis. The predictive models revealed that increased age and longer ICU stays are predictors for both pressure injury development and progression to severe stages, while Braden scores predict the likelihood of developing severe stages of pressure injuries.

This study has identified a benchmark for pressure injury prevalence in critical care units in Saudi Arabia. The results demonstrate that pressure injuries can be prevented in critically ill patients when evidence-based education strategies are implemented.

Pressure injuries are an important issue for critically ill patients and can be prevented with proper investments. Strategies to prevent pressure injuries from admission will result in fewer pressure injuries.

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and the Template for Intervention Description and Replication (TIDieR) checklist.

No patient or public contribution.

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

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

A retrospective case-control study.

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

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

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

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

To explore nurses' knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention.

A pre-and post-intervention study. Pre-intervention data collection involved administering an instrument, including demographic information, the Pressure Ulcer Knowledge Assessment Tool version 2, and the Attitudes towards Pressure Ulcer Prevention instruments. Following the analysis of pre-intervention data, an educational intervention was implemented. Post-intervention data were collected using the same instrument.

Intensive care units at three Saudi Arabian hospitals.

Nurses' knowledge and attitudes towards pressure injury prevention.

The pre-intervention phase included 190 participants, and the post-intervention phase included 195 participants. Participants completed a paper-based survey at two different time points between June 2021 and March 2022. The mean pre-intervention scores for nurses' knowledge and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively. Following the educational intervention, the knowledge and attitude scores increased significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury prevention was positively associated with positive attitudes towards prevention practices. Age, clinical nursing experience, and experience in intensive care units were identified as factors correlated with knowledge of pressure injury prevention. A Bachelor's qualification or higher predicted better knowledge and attitudes towards pressure injury prevention.

Nurses' knowledge and attitudes towards pressure injury prevention greatly improved following tailored, evidence-based education. The educational intervention featured multiple on-site bedside discussions, case studies, small-group presentations, and the provision of printed resources.

Nurses' knowledge and attitudes towards pressure injury prevention should be examined, and education provided to ensure evidence-based prevention practices are implemented. Tailored small-group education sessions delivered conveniently could be an effective approach. Efforts should focus on attracting and retaining experienced, highly qualified nurses to ensure the adoption of evidence-based prevention practices.

Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs.

An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location.

Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026).

This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.

As a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale.

A single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines.

During the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers' adherence and workload, and the rate of adverse events.

In the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90).

A personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial.

This Clinical Practice Guideline addresses early mobilization and rehabilitation (EMR) of critically ill adult burn patients in an intensive care unit (ICU) setting. We defined EMR as any systematic or protocolized intervention that could include muscle activation, active exercises in bed, active resistance exercises, active side-to-side turning, or mobilization to sitting at the bedside, standing, or walking, including mobilization using assistance with hoists or tilt tables, which was initiated within at least 14 days of injury, while the patient was still in an ICU setting. After developing relevant PICO (Population, Intervention, Comparator, Outcomes) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations were formulated through the consensus of a multidisciplinary committee, which included burn nurses, physicians, and rehabilitation therapists, based on the available scientific evidence. No recommendation could be formed on the use of EMR to reduce the duration of mechanical ventilation in the burn ICU, but we conditionally recommend the use of EMR to reduce ICU-acquired weakness in critically ill burn patients. No recommendation could be made regarding EMR's effects on the development of hospital-acquired pressure injuries or disruption or damage to the skin grafts and skin substitutes. We conditionally recommend the use of EMR to reduce delirium in critically ill burn patients in the ICU.

Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU.

We retrospectively analyzed patients ages &gt; 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics.

We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011).

The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, "friction and shear" was associated with the development of pressure injuries in ICU patients.

The aim of this systematic review is to identify the current epidemiological evidence indicating the unique risk factors for deep tissue injury (DTI) compared to grade I-IV pressure injury (PI), the proportion of DTI which evolve rather than resolve and the anatomical distribution of DTI.

A systematic literature search was undertaken using the MEDLINE and CINAHL Plus databases using the search terms 'Deep tissue injury OR DTI [Title/abstract]'. A google scholar search was also conducted in addition to hand searches of relevant journals, websites and books which were identified from reference lists in retrieved articles. Only peer-reviewed English language articles published 2009-2021 were included, with full text available online.

The final qualitative analysis included nine articles. These included n = 4 retrospective studies, n = 4 prospective studies and n = 1 animal study.

The literature indicates that the majority of DTI occur at the heel and sacrum although in paediatric patients they are mainly associated with medical devices. Most DTI are reported to resolve, with between 9.3 and 27% deteriorating to full thickness tissue loss. Risk factors unique to DTI appear to include anaemia, vasopressor use, haemodialysis and nicotine use although it is unclear if these factors are unique to DTI or are shared with grade I-IV PI. Factors associated with deterioration include cooler skin measured using infrared thermography and negative capillary refill. With 100% of DTI showing positive capillary refill in one study resolving without tissue loss (p = 0.02) suggesting this may be an effective prognostic indicator. More prospective studies are required focusing on establishing causal links between risk factors identified in earlier retrospective studies. Ideally these should use statistically powered samples and sufficient follow up periods allowing DTI outcomes to be reached. Further work is also needed to establish reliable diagnostic criteria for DTI in addition to more studies in the paediatric population.

The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019.

Observational, cohort study with cross-sectional data collection and retrospective data analysis.

The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions.

Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury).

The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found.

Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.

To report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries.

A prospective observational design where observations of patients' skin integrity were conducted on one day each week for 52 weeks.

The study was conducted in the 36-bed ICU of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ.

The primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded.

Over the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI. The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09-1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02-1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18-3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01-1.09, p = 0.013).

Device related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.