Mucosal membrane pressure injury in intensive care units: A scoping review

Risk factors for oral mucosal pressure injury associated with endotracheal tubes in intensive care unit patients: A single-centre longitudinal study with brief follow-up

BACKGROUND

In intensive care units (ICUs), endotracheal tubes (ETTs) cause injury to the oral mucosa through friction and pressure. The incidence and risk factors of oral mucosal pressure injuries (PIs) have gained increasing attention in recent years.

AIM

The study aimed to identify risk factors for oral mucosal PIs associated with ETTs.

STUDY DESIGN

This was a single-centre brief follow-up longitudinal study conducted from January to May 2022. It recruited 250 patients without oral mucosal PIs who received mechanical ventilation support via ETT and were hospitalized in the ICU of a teaching and research hospital in Turkey. Receiver operating characteristic (ROC) analysis was performed to estimate the onset time of oral mucosal PI using the ETT repositioning time as an independent variable.

RESULTS

Oral mucosal PIs associated with ETT developed in 41.6% of patients. Of the 250 endotracheally intubated patients, the mean Acute Physiology and Chronic Health Evaluation (APACHE-II) score was 27.5 (min/max: 18/42), the mean length of stay (LOS) in the ICU was 24 days (min/max: 13/80). The median body mass index (BMI) of patients with oral mucosal PIs was (24.59 [IQR = 3.81] kg/m2), significantly lower than the median BMI of patients without oral mucosal PIs (26.62 [IQR = 5.93] kg/m2) (Z = 4.200; p < .001). The earliest onset of oral mucosal PIs was noted at 16 h after the start of follow-up, and the latest was 208 h after the start of follow-up, with a median of 160 (IQR = 48) h (approximately 6.7 days). Patients whose ETT was repositioned after 10.5 h had a higher risk of developing oral mucosal PIs (OR = 3.77; 95% CI: 2.65-5.37; p < .001). The decision tree (CHAID) method was applied to determine the time required to reposition the ETT to prevent oral mucosal PIs. The decision tree correctly classified the occurrence of oral mucosal PIs by 60.6% and the non-occurrence of oral mucosal PIs by 97.9%. Patients with parenteral nutrition and a low frequency of ETT repositioning time had a higher risk of oral mucosal PIs (p < .001).

CONCLUSIONS

Parenteral nutrition support and ETT repositioning timing were the primary risk factors for developing oral mucosal PIs. Close monitoring of endotracheally intubated patients receiving parenteral nutrition is essential, with particular attention to forming oral mucosal PIs. Additionally, repositioning the ETT at intervals of no more than 8 h may help reduce the risk of oral mucosal PI development.

RELEVANCE TO CLINICAL PRACTICE

As ICU patients are particularly vulnerable to mucosal membrane PIs, recognizing the associated risk factors is crucial for early detection and prevention. This study highlights the specific risk factors for oral mucosal PIs, equipping nurses with the knowledge to develop targeted interventions to prevent these injuries.

Knowledge levels and attitudes of Turkish nursing students regarding medical device-related pressure injuries and factors influencing them: A cross-sectional study

AIM

The aim of this study was to determine nursing students' levels of knowledge and attitudes regarding medical device-related pressure injuries (MDRPIs), as well as the factors influencing these.

MATERIALS AND METHODS

This descriptive and cross-sectional study was conducted with 581 nursing students between January and May 2024. Data were collected using the Student Information Form, the Medical Device Related Pressure Injury Knowledge Assessment Test (MDRPI-KAT), and the Medical Device Related Pressure Injury Attitude Questionnaire (MDRPI-AQ).

RESULTS

The nursing students had a mean score of 8.76 ± 2.68 on the MDRPI-KAT, indicating an overall correct answer percentage of 54.7 %. The mean total score on the MDRPI-AQ was 44.08 ± 8.12. Furthermore, 75.0 % of the nursing students (n = 436) achieved a positive attitude score (>40 points). According to the results of the structural equation model, the scores on the MDRPI-KAT among nursing students had a statistically significant effect on their scores on the MDRPI-AQ (β = 0.585, p = 0.002).

CONCLUSION

This study found that the nursing students exhibited insufficient knowledge about MDRPIs.Despite this, the nursing students demonstrated a positive attitude toward MDRPIs.

The frequency of pressure injury in level 3 intensive care units and determination of risk factors: A cross-sectional study

AIM

This study was carried out to determine the prevalence of pressure injury and risk factors in patients hospitalized in a university hospital's level 3 intensive care unit.

DESIGN

It is a descriptive, prospective, observational type study.

METHOD

The sample of the study consisted of 176 patients aged 18 and over who were admitted to the intensive care units of a University Hospital for at least 24 h. Patient Information Form and Braden Risk Assessment Scale, Glasgow Coma Scale were used to collect data. IBM SPSS Statistics 20 program was used to analyze the data.

RESULTS

Presence of chronic disease in the development of pressure injury (22.7%), high-risk patients according to the Glasgow Coma Scale (21%), high-risk patients according to the Braden Risk Assessment Scale (84.2%), low hemoglobin (31%), low albumin levels (32.4%) and duration of stay in the intensive care unit until the day of evaluation were found to be independent risk factors (p < 0.05). The prevalence of pressure injury was determined to be 32.4%, and the rate of pressure injury due to medical devices was 7.4%.

CONCLUSION

Pressure injuries are still common in adult intensive care patients. In terms of patient safety, it is important to give more space to care standards and awareness-raising research and training to prevent pressure injuries.