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Cai Y, Chen H, Chen Z, Chen Q, Su Y, Chen F, Pan J, Yang Y, Hu Z, Li W, Liao H, Sun T, Cheng J, Chen W, Zhang B, Chen R. Nomogram model for predicting pressure injury in COPD patients using SII: a Chinese clinical study. Front Med (Lausanne) 2025; 12:1564099. [PMID: 40297157 PMCID: PMC12034554 DOI: 10.3389/fmed.2025.1564099] [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: 01/22/2025] [Accepted: 03/27/2025] [Indexed: 04/30/2025] Open
Abstract
Objectives This study aims to investigate the association between the Systemic Immune-Inflammation Index (SII) and the development of pressure injuries (PI) in patients with chronic obstructive pulmonary disease (COPD). Additionally, a nomogram model based on the SII will be constructed to predict the probability of pressure injury (PI) occurrence in patients with COPD. Methods A retrospective analysis was performed on the clinical data of 844 patients with COPD who were admitted to the Affiliated Hospital of Guangdong Medical University between June 2018 and December 2019. Logistic regression analysis was employed to identify risk factors associated with the development of PI, and the Wald chi-square test was used to select variables for constructing a predictive nomogram. The performance of the nomogram was assessed, followed by internal validation. Additionally, clinical data from 452 patients with COPD admitted to the Second Affiliated Hospital of Guangdong Medical University between January 2024 and December 2024 were prospectively collected for external validation. Results A total of 844 patients with COPD were included in this study, with 590 cases in the training group and 254 cases in the internal validation group. The predictors included in the nomogram model were age, respiratory rate [Breathe (R)], duration of COPD history, Serum albumin (ALB), SII, paralysis, edema, and activities of daily living (ADL). The nomogram demonstrated strong predictive performance and calibration. The area under the curve and 95% confidence intervals were 0.77 (0.72-0.82) for the training group, 0.77 (0.70-0.85) for the internal validation group, and 0.73 (0.66-0.81) for the external validation group. Conclusion This study identified the SII, age, respiratory rate, duration of COPD history, ALB, paralysis, and ADL as independent risk factors for the development of PI in patients with COPD. A nomogram model was successfully developed based on SII and validated through both internal and external testing. The findings suggest that SII is a reliable predictor of PI development in patients with COPD, and the model demonstrates strong predictive performance.
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Affiliation(s)
- Yuli Cai
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Huimin Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhaojun Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qinghua Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yihuan Su
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Feiju Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jingjing Pan
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yitian Yang
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhongxing Hu
- The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenxi Li
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Huizhao Liao
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tingting Sun
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junfen Cheng
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Wenliang Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Baozhi Zhang
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Riken Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Han L, Kang X, Tao H, Zhang H, Wang Y, Lv L, Ma Y. The relationship between arterial partial pressure of oxygen and pressure injuries in intensive care unit patients: A multi-center cross-sectional study. Intensive Crit Care Nurs 2025; 86:103785. [PMID: 39326238 DOI: 10.1016/j.iccn.2024.103785] [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: 04/20/2024] [Revised: 07/03/2024] [Accepted: 07/23/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Pressure injuries significantly impact patients in intensive care units and the healthcare system. Hypoxia, a major contributor to pressure injury development, can be promptly identified by monitoring arterial partial pressure of oxygen. However, the dose-response relationship between arterial partial pressure of oxygen and pressure injuries remains unclear. OBJECTIVES To determine how mean arterial partial pressure of oxygen within 24 h before the appearance of a pressure injury influences pressure injury outcomes in ICU patients, elucidating the dose-response relationship, and underscoring the importance of including arterial oxygen pressure in routine pressure injury risk assessments. METHODS We conducted this multi-center cross-sectional study in Gansu province of China from April 2021 to July 2023. The incidence and influencing factors of pressure injuries were collected. Logistic and restricted cubic spline regression analyses were used to assess the association between pressure injuries and arterial partial pressure of oxygen. Subgroup analyses stratified by age and sex were conducted to explore potential correlations. RESULTS Among 6078 participants, the incidence of pressure injury was 2.34 %. After adjusting for all confounding factors, patients with low arterial partial pressure of oxygen were more likely to develop pressure injury than those with normal levels (OR 1.753, 95 %CI 1.142 ∼ 2.693). The dose-response relationship shows a significant non-linear dose-response correlation between arterial partial pressure of oxygen and pressure injury risk (P = 0.011). Layered analysis shows that the impact is more pronounced in older individuals and males. CONCLUSIONS As arterial partial pressure of oxygen decreases, the occurrence of pressure injuries gradually increases. Incorporating arterial partial pressure of oxygen into daily pressure injury risk assessments is crucial. IMPLICATIONS FOR CLINICAL PRACTICE Our study results will offer targeted insights for the prevention and management of pressure injuries.
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Affiliation(s)
- Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China.
| | - Xinmian Kang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongxia Tao
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China
| | - Yahan Wang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Lin Lv
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China.
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Jia YJ, Hu FH, Zhang WQ, Tang W, Ge MW, Shen WQ, Chen HL. Incidence, prevalence and risk factors of device-related pressure injuries in adult intensive care unit: A meta-analysis of 10,084 patients from 11 countries. Wound Repair Regen 2023; 31:713-722. [PMID: 37587087 DOI: 10.1111/wrr.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
Device-related pressure injuries (DRPIs) prevail in the intensive care unit (ICU) and have much to do with medical devices and patients' conditions. This meta-analysis aims to systematically assess the incidence, prevalence and risk factors related to DRPIs among adults in ICU. Web of Science, Cochrane Library, MEDLINE, PubMed and CINAHL were searched from inception to March 2023. Observational studies were included, and the Newcastle-Ottawa scale (NOS) was used to assess literature quality. The primary outcomes were the incidence, prevalence and risk factors regarding DRPIs among adults in ICU. The 19 studies conformed to the criteria for inclusion in the review. The estimated pooled incidence of DRPIs was 14.7% (95% CI: 9.7%-19.6%) in 10 studies (4866 participants). The estimated pooled prevalence of DRPIs was 19.0% (95% CI: 13.6%-24.3%) in 9 studies (5218 participants). The most significant risk factor for DRPIs was using mechanical ventilation. The pooled analysis of the four studies showed that DRPIs were more likely to occur in patients who required mechanical ventilation compared with patients who did not use mechanical ventilation (OR: 9.67, 95% CI: 5.03-18.61, p < 0.001) and using vasopressors, age, length of ICU stays, APACHE II score, Braden score, fever, sex, oedema, diabetes and number of medical devices, SOFA score was also related to pressure injuries risk. The incidence and prevalence of DRPIs in adult ICU were high, and the most significant risk factor for DRPIs was using mechanical ventilation. It is imminent to identify patients of increased risk with DRPIs early.
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Affiliation(s)
- Yi-Jie Jia
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Fei-Hong Hu
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wan-Qing Zhang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wen Tang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Meng-Wei Ge
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wang-Qin Shen
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, People's Republic of China
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Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen 2022; 30:498-508. [PMID: 35589532 DOI: 10.1111/wrr.13021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
The present study was designed to determine the association between Acute Physiology and Chronic Health Evaluation (APACHE) scale and elevated pressure injure (PI) risk in intensive care units (ICU) and also evaluate the predictive value of APACHE score in PI patients. Comprehensive strategies were used to search studies from PubMed, Web of Science, and Ovid Embase electronic databases for observational studies that provided data about APACHE scores related to PI in ICU. Eligible studies were selected based on inclusion and exclusion criteria. The pooled SMD with 95% confidence intervals were calculated. A summary ROC curve was plotted to calculate area under curve (AUC) for APACHE-II (15-20). Twenty-one studies involving 11,102 patients who met selection criteria were included. The 11.0% of patients (1229/11102) in ICU developed PIs. Overall, the PI group had a higher score compared with the non-PI group in the APACHE II (22.1 ± 8.0 vs. 14.5 ± 7.4, mean ± SD). The APACHE-III of PI patients was significantly more than that in the non-PI group (79.9 ± 25.6 vs. 59.9 ± 30.4, mean ± SD). The pooled SMD was 0.82 (95% CI: 0.58-1.06, I2 = 91.7%, p-value < 0.001). The subgroup analysis revealed that the risk of PIs did not vary with the type of APACHE score (II, III, IV) and the type of study design (case-control, cross-sectional, cohort, longitudinal study). Proportion of males (I2 = 91.68%, p value = 0.090), publish year (I2 = 91.96%, p value = 0.187) and mean age of patients (I2 = 91.96%, p value = 0.937) were not the sources of heterogeneity. APACHE-II (15-20) achieves the best predictive performance in PI, and the prediction accuracy was balanced with equal sensitivity and specificity (Sen: 0.72, 0.62-0.80; Spec: 1.72, 1.25-2.38). In conclusion, higher APACHE scores are frequently accompanied by a higher incidence of PI among critical-care patients. APACHE-II scores (15-20) satisfactorily predicted PI, and strategies to prevent PI should be aggressively implemented.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Man-Li Zha
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Baron MV, dos Santos MP, Werle TM, Scherer GD, Santos MMD, Dominguez LML, Brandenburg C, Feltez G, Sampaio AR, de Mello Pinto MV, Carvalho S, Meyer PF, Picariello F, Pacheco EF, Reinheimer IC, Sancho AG, da Costa BEP. Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review. Medicine (Baltimore) 2022; 101:e29058. [PMID: 35356924 PMCID: PMC10513310 DOI: 10.1097/md.0000000000029058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/24/2022] [Indexed: 02/02/2023] Open
Abstract
ABSTRACT Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.
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Affiliation(s)
- Miriam Viviane Baron
- Correspondence: Miriam Viviane Baron, Graduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul 90619-900, Brazil (e-mail: ).
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Sianes-Gallén M, Pujol-García AM, Rus García M, Partera Luque C, López Postigo M, Call Mañosa S, Camposo Montesino MC, Ibáñez Touriño B, Ribas Obon E, Segura Rodríguez T, Cores Fuentes P, Tamame Sanantonio M, Jornet-Gibert M. Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study. J Tissue Viability 2021; 30:478-483. [PMID: 34389188 PMCID: PMC8328527 DOI: 10.1016/j.jtv.2021.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 01/21/2023]
Abstract
AIM OF STUDY The main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. MATERIAL AND METHODS A retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. RESULTS High baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. CONCLUSIONS SARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.
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Affiliation(s)
- Mònica Sianes-Gallén
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Anna María Pujol-García
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Montserrat Rus García
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Carmen Partera Luque
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Montserrat López Postigo
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Silvia Call Mañosa
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - María Carmen Camposo Montesino
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Belén Ibáñez Touriño
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Eulalia Ribas Obon
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Tania Segura Rodríguez
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Pilar Cores Fuentes
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Marta Tamame Sanantonio
- Nurses Unit, Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - Montsant Jornet-Gibert
- Parc Taulí Hospital Universitari, Institut D'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
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Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients. Adv Skin Wound Care 2021; 33:260-266. [PMID: 32304449 DOI: 10.1097/01.asw.0000658584.09988.fa] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the incidence and influencing factors of medical adhesive-related skin injury (MARSI) among ICU patients. METHODS Study authors enrolled patients admitted to two ICUs at a class 3, grade A hospital in Beijing between January and June 2018 in this prospective cohort study. A data collection sheet was designed, and the data were collected by querying the electronic medical record and via direct assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that independently influenced MARSI incidence. The STROBE checklist was used. RESULTS In total, 39 of 356 patients (27 men and 12 women with an average age of 61.51 ± 17.49 years) developed MARSI, an incidence of 10.96%. The median time from admission to MARSI occurrence was 26 days. Multivariate logistic regression analysis revealed that the ICU length of stay, Braden Scale score, and mechanical ventilation all independently influenced incidence. The Braden Scale score (odds ratio [OR], 0.758; 95% confidence interval [CI], 0.636-0.904; P < .05) was a protective factor against MARSI, with higher scores indicating lower risk. The ICU length of stay (OR, 1.098; 95% CI, 1.061-1.136; P < .05) and mechanical ventilation (OR, 3.373; 95% CI, 0.889-12.795; P < .05) were independent risk factors for MARSI. CONCLUSIONS The incidence of MARSI in ICU patients was relatively high. Awareness of MARSI should be increased among medical staff, and proper skin care should be provided to prevent and treat MARSI effectively.
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Preventing Pressure Injuries in Nursing Home Residents Using a Low-Profile Alternating Pressure Overlay: A Point-of-Care Trial. Adv Skin Wound Care 2020; 33:533-539. [PMID: 32941227 DOI: 10.1097/01.asw.0000695756.80461.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pressure injuries (PIs) are a significant concern for patients with very limited mobility in skilled nursing facilities. Conflicting clinical guidelines and a lack of effectiveness data for the various support surfaces reduces the efficacy of PI prevention programs. OBJECTIVE To assess the preventive effectiveness (incidence of facility-acquired PIs) of a low-profile alternating pressure (AP) support surface plus facility-specific PI prevention programs in patients at high risk for PI. DESIGN AND SETTING Prospective, multicenter, point-of-care observational study in two for-profit nursing homes in the northeastern US. PATIENTS AND INTERVENTION A retrospective review of 101 residents was performed to determine baseline PI incidence. Then, a consecutive sample of 25 participants was selected based on the following eligibility criteria: high risk for PI, bedbound (20 hours or more per day), and stay in a mechanical ventilation unit for more than 5 days. The participants were placed on an AP overlay positioned above a facility-provided nonpowered reactive support surface. MAIN OUTCOME MEASURE The development of any new PI (stage 1-4), deep-tissue injury, or unstageable PI in participants using the AP overlay. The PI incidence for the AP group was compared with the retrospective baseline PI incidence from the same units in the two nursing homes. MAIN RESULTS The group using the AP overlay had a significantly lower PI incidence (0/25, 0%) compared with baseline (22/101, 21.8%; P < .001). Almost 80% of the study participants in the AP group were completely immobile, 100% of the participants were bowel- and bladder-incontinent, their average time on the AP overlay was 140.9 ± 94.1 days, and average length of stay in the facility was 633.9 ± 1,129.1 days. CONCLUSIONS The low-profile AP overlay was significantly more effective than facility-specific prevention programs alone in preventing PIs in a high-risk nursing home population over an extended period.
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Gong X, Chen HL, Shen JH, Zhu BF. Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study. J Wound Care 2019; 28:527-531. [PMID: 31393797 DOI: 10.12968/jowc.2019.28.8.527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department. METHODS The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR). RESULTS A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224). CONCLUSION Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.
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Affiliation(s)
- Xiang Gong
- Senior Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
| | - Hong-Lin Chen
- Associate Professor, Nantong University, School of Nursing
| | - Jun-Hua Shen
- Senior Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
| | - Bao-Feng Zhu
- Chief Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
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Cox J, Schallom M. Pressure Injuries in Critical Care: A Survey of Critical Care Nurses. Crit Care Nurse 2018; 37:46-55. [PMID: 28966195 DOI: 10.4037/ccn2017928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critical care nurses must be able to skillfully balance the prevention of adverse events such as pressure injuries in an environment with multiple competing and lifesaving technologies that often take precedent. Despite strategies to prevent them, pressure injuries do occur in intensive care unit patients, and consensus is building that some pressure injuries are unavoidable. OBJECTIVES To determine critical care nurses' attitudes toward prevention of pressure injury and the perceptions of frontline critical care nurses of specific risk factors associated with unavoidable pressure injuries. METHODS A descriptive cross-sectional survey design was used. An online survey was posted on the newsletter website of the American Association of Critical-Care Nurses in January 2016. RESULTS An invitation to participate in the study was emailed to more than 3000 members of the association; 333 nurses responded, for a response rate of approximately 11%. Among the responders, 73% were employed as bedside critical care nurses. More than half (67%) thought that pressure injuries are avoidable, and 66% disagreed that pressure injury prevention was of less interest than other aspects of critical care. The top 2 risk factors for unavoidable pressure injuries were impaired tissue perfusion and impaired tissue oxygenation. CONCLUSION Critical care nurses are steadfast stewards of safe patient care and think that pressure injury prevention is a crucial aspect of the care they deliver every day. The findings on risk factors for unavoidable pressure injuries mirrored those of experts and provide a layer of support for these factors.
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Affiliation(s)
- Jill Cox
- Jill Cox is clinical associate professor, School of Nursing, Rutgers University, Newark, New Jersey, and a wound/ostomy/continence advanced practice nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Marilyn Schallom is a clinical nurse specialist and research scientist, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri.
| | - Marilyn Schallom
- Jill Cox is clinical associate professor, School of Nursing, Rutgers University, Newark, New Jersey, and a wound/ostomy/continence advanced practice nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Marilyn Schallom is a clinical nurse specialist and research scientist, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
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Chen JH, Wu SC, Chen HJ, Kao CH, Tseng CH, Tsai CH. Risk of developing pressure sore in amyotrophic lateral sclerosis patients - a nationwide cohort study. J Eur Acad Dermatol Venereol 2018; 32:1589-1596. [PMID: 29512203 DOI: 10.1111/jdv.14911] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept. OBJECTIVE To investigate whether patients with ALS have higher risk of PrS. METHODS Utilizing a Taiwan National Insurance claims data set with 23 million participants, we extracted 514 patients with ALS and 2056 controls from 1 January 2000 to 31 December 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model. RESULTS The patients with ALS had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90-15.9, P < 0.001) than the controls did. PrS risk was much higher in ALS women (aHR = 26.6, 95% CI = 9.05-78.2, P < 0.001) than in ALS men (aHR = 4.38, 95% CI = 1.99-9.68, P < 0.001). Besides, in people aged 20-54, ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79-132, P < 0.001) than in those aged ≥55 (aHR = 6.10, 95% CI = 3.10-12.0, P < 0.001). CONCLUSIONS Amyotrophic lateral sclerosis is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the patients with ALS, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study.
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Affiliation(s)
- J-H Chen
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - S-C Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| | - H-J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - C-H Kao
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tseng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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Differentiating a Pressure Ulcer from Acute Skin Failure in the Adult Critical Care Patient. Adv Skin Wound Care 2017; 28:514-24; quiz 525-6. [PMID: 26479695 DOI: 10.1097/01.asw.0000471876.11836.dc] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF. ABSTRACT To develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories: (1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio [OR], 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners-the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidence-based practice to patients.
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Kalowes P, Messina V, Li M. Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit. Am J Crit Care 2016; 25:e108-e119. [PMID: 27802960 DOI: 10.4037/ajcc2016875] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. OBJECTIVES To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care. Secondary goals were to examine risk factors for HAPUs in critically ill patients and to explicate cost savings related to prevention of pressure ulcers. METHODS A prospective, randomized controlled trial in the intensive care units at a 569-bed, level II trauma hospital. All 366 participants received standard pressure ulcer prevention; 184 were randomized to have a 5-layered soft silicone foam dressing applied to the sacrum (intervention group) and 182 to receive usual care (control group). RESULTS The incidence rate of HAPUs was significantly less in patients treated with the foam dressing than in the control group (0.7% vs 5.9%, P = .01). Time to injury survival analysis (Cox proportional hazard models) revealed the intervention group had 88% reduced risk of HAPU development (hazard ratio, 0.12 [95% CI, 0.02-0.98], P = .048). CONCLUSION Use of a soft silicone foam dressing combined with preventive care yielded a statistically and clinically significant benefit in reducing the incidence rate and severity of HAPUs in intensive care patients. This novel, cost-effective method can reduce HAPU incidence in critically ill patients.
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Affiliation(s)
- Peggy Kalowes
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
| | - Valerie Messina
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
| | - Melanie Li
- Peggy Kalowes is director, Nursing Research, Innovation and Evidence-Based Practice; Valerie Messina is a certified wound care nurse and director of the wound care program; and Melanie Li is a certified wound ostomy continence nurse, Long Beach Memorial, Miller Children’s and Women’s Hospital, Long Beach, California
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Bly D, Schallom M, Sona C, Klinkenberg D. A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit. Am J Crit Care 2016; 25:156-64. [PMID: 26932918 DOI: 10.4037/ajcc2016840] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although most intensive care patients are at risk for pressure ulcers, not all experience such ulcers. OBJECTIVE To examine a model of variables related to extrinsic and intrinsic pressure on skin and underlying tissues, oxygenation, perfusion, and baseline comorbid conditions to identify risk factors associated with pressure ulcers in critically ill adults. METHOD A retrospective chart review was conducted on patients identified by weekly rounds from January 2010 through October 2010 to determine the prevalence of pressure ulcers. Variables were analyzed via bivariate analysis and logistic regression for unit-acquired pressure ulcers. RESULTS Data on 345 patients with 436 intensive care admissions were reviewed. Variables were significant in each model category at P < .05. In the regression analysis of first admission only (n = 306), the model was significant (P < .001) and yielded correct classification of 86.3% of patients. For all intensive care admissions (n = 391), the model was significant (P < .001) and yielded correct classification of 83.9% of patients. In both models, 4 of the same variables were significant: any transport off the unit, number of days to bed change, systolic blood pressure less than 90 mm Hg, and use of more than 1 vasopressor. History of pulmonary disease and presence of a feeding tube were also significant in regression analyses. CONCLUSIONS Several variables within the model of pressure, oxygenation, and perfusion were significantly associated with development of pressure ulcers.
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Affiliation(s)
- Deborah Bly
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Marilyn Schallom
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Carrie Sona
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
| | - Dean Klinkenberg
- Deborah Bly is a staff nurse in the medical intensive care unit, Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Carrie Sona is a clinical nurse specialist in the surgical intensive care unit, and Dean Klinkenberg is lead statistical analyst in the Department of Research for Patient Care Services, Barnes-Jewish Hospital at Washington University, St Louis, Missouri
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Pittman J, Beeson T, Terry C, Dillon J, Hampton C, Kerley D, Mosier J, Gumiela E, Tucker J. Unavoidable Pressure Ulcers. J Wound Ostomy Continence Nurs 2016; 43:32-8. [DOI: 10.1097/won.0000000000000191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cox J, Roche S. Vasopressors and development of pressure ulcers in adult critical care patients. Am J Crit Care 2015; 24:501-10. [PMID: 26523008 DOI: 10.4037/ajcc2015123] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. OBJECTIVE To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. METHODS A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. RESULTS Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. CONCLUSION The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.
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Affiliation(s)
- Jill Cox
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
| | - Sharon Roche
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
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Nassaji M, Askari Z, Ghorbani R. Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. Int J Nurs Pract 2013; 20:418-23. [PMID: 25157943 DOI: 10.1111/ijn.12141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess relationship between smoking, some other risk factors and ulcers development in intensive care unit. This prospective cohort study was performed in two university-affiliated hospitals. The sample consisted of adult male patients who were admitted to medical-surgical intensive care units. All eligible patients were grouped according to their cigarette smoking status as smoker and non-smoker. The final sample included 160 smokers and 192 non-smokers. Pressure ulcer occurred in 62 smoker patients and 28 of non-smoker who showed significant difference. Also number of pack-year of cigarettes smoking showed significant association with ulcer development. Ulcer stage was significantly different between the two groups. Besides of smoking, age, length of stay, faecal incontinency, diabetes mellitus, anaemia and trauma were significantly associated with pressure ulcers. Our study showed significant association between smoking and development of pressure ulcers.
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Affiliation(s)
- Mohammad Nassaji
- Department of Infectious Diseases, Fatemieh Hospital, Semnan University of Medical Science, Semnan, Iran
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Context for WOC Practice. J Wound Ostomy Continence Nurs 2012; 39:123-5. [DOI: 10.1097/won.0b013e3182480769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Comparison between the Use of Intravenous Bags and the Heelift Suspension Boot to Prevent Pressure Ulcers in Orthopedic Patients. Adv Skin Wound Care 2012; 25:125-31. [DOI: 10.1097/01.asw.0000412909.81452.b6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available. OBJECTIVE To determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions. METHODS A retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009. RESULTS According to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers. CONCLUSION Current risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.
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Affiliation(s)
- Jill Cox
- Jill Cox is an advanced practice nurse and a wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey
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