Pressure ulcers: the core, care and cure approach

The successful healing effect of local Taurolidine irrigation for treating deep pressure ulcers: a case report

BACKGROUND

Pressure ulcers, particularly stage III and IV lesions, pose a significant healthcare challenge owing to their high morbidity, economic burden, and recalcitrance to conventional therapies. Current management often includes systemic antibiotics, debridement, and advanced wound dressings, yet outcomes remain suboptimal in many cases. Innovative approaches to wound care are needed to address this gap.

CASE PRESENTATION

We report a case of a 17-year-old Iranian paraplegic male with a stage III sacral pressure ulcer complicated by an underlying abscess and exposed bone. Despite systemic antibiotics, regular debridement, and dressing changes, the ulcer failed to heal. The introduction of serial Taurolidine irrigation, combined with limited application of cryopreserved human amniotic membrane, resulted in progressive wound granulation and complete reepithelialization within 2 months. The patient experienced no adverse effects and maintained complete healing at follow-ups up to 1 year.

CONCLUSION

This case highlights the potential of Taurolidine as a novel antiseptic and wound-healing agent for recalcitrant pressure ulcers. Taurolidine irrigation demonstrated efficacy in achieving complete ulcer healing, suggesting its role as a promising therapeutic option for challenging wound infections.

Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study

Background

Although substantial evidence exists regarding the treatment of pressure ulcers, there is a lack of studies demonstrating a comprehensive nursing approach for managing pressure ulcers in the ICU, particularly among patients with invasive mechanical ventilation from developing countries like Honduras. This gap in research is significant as the risk and impact of pressure ulcers on health recovery cannot be disregarded.

Objective

This study aimed to analyze Honduran nursing care for pressure ulcers in patients with invasive mechanical ventilation admitted to Intensive Care Units.

Methods

A qualitative study approach was used, with in-depth interviews conducted with 12 critical care nurses from July to September 2022. The interviews were recorded, and data analysis was performed using the participants' narratives following Colaizzi's steps.

Results

Three themes were obtained, which provide insight into the phenomenon: "The strengths in Honduran nursing interventions," "Negligence in the Honduran nursing care processes," and "Vulnerabilities in the organizational structures."

Conclusion

Nurses' experiences highlighted their timely reports and comprehensive, holistic care. However, they undergo negligence in their caring processes, such as low frequency of repositioning, lack of caring plans, and absence of self-training, leading to interdisciplinary work codependency for decision-making. Allocating resources toward nursing care and their professional growth is an investment in providing humane treatment and ensuring the prevention and management of pressure injuries in critical care patients. This study highlights the importance of comprehensive training and standardized protocols for intensive care nurses to improve pressure injury prevention and management in mechanically ventilated patients, emphasizing the need for regular patient repositioning, effective communication, and adequate resources to enhance patient care quality.

PTGS2 as target of compound Huangbai liquid in the nursing of pressure ulcer

OBJECTIVE

Pressure ulcer refers to ulceration and necrosis caused by local skin and cell tissues being compressed for a long time, continuous ischemia, hypoxia, and malnutrition. However, role of prostaglandin-endoperoxide synthase 2 (PTGS2) in the management of pressure ulcers in with compound Huangbai liquid is still unclear.

METHODS

Traditional Chinese medicine components and related targets of compound Huangbai liquid were collected through traditional Chinese medicine systems pharmacology (TCMSP) and Batman-traditional Chinese medicine database. Disease-related targets were obtained using the Gene Cards database. The protein-protein interaction (PPI) network was constructed using the Search tool for retrieval of interacting genes (STRING) and analyzed by Cytoscape to obtain the core components. To evaluate the clinical efficacy of the compound Huangbai liquid in the treatment of pressure ulcers, 40 patients with pressure ulcers were selected and divided into an observation group and a control group, with 20 individuals in each group. The observation group received treatment with compound Huangbai liquid.

RESULTS

Sixty-five components and 480 targets of compound Huangbai liquid were obtained from TCMSP and Batman - traditional Chinese medicine databases. Two hundred seventy-three pressure ulcer-related targets were obtained. Seventy-two potential targets of compound Huangbai pigment in treatment of pressure ulcer were obtained, and 2 unrelated targets were deleted. There were 70 nodes and 1167 edges in PPI network. Gene ontology (GO) function is involved in biological processes such as reactive oxygen species metabolism and cellular response to chemical stress. Cellular components such as platelet α granules lumen and membrane rafts were involved. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment results showed that compound Huangbai liquid in treatment of pressure ulcer. The clinical results indicate that the compound Huangbai liquid has a good therapeutic effect on pressure ulcers.

CONCLUSION

PTGS2 may be a target for treatment of pressure ulcers with compound Huangbai liquid, providing a new direction for its treatment.

Effect of comprehensive nursing intervention on the formation of pressure sore in patients undergoing orthopaedic surgery in prone position

Pressure ulcers are a common complication of prone orthopaedic surgery, causing pain and inconvenience to patients. This study aimed to evaluate a comprehensive nursing intervention for pressure ulcer formation in these patients. A total of 120 patients undergoing prone orthopaedic surgery were randomly divided into two groups. The study group (60 patients) received a comprehensive nursing intervention, whereas the control group (60 patients) received a routine nursing intervention. After 2 weeks, the comprehensive nursing intervention significantly reduced the incidence and degree of pressure sores and led to a shorter recovery time than the routine nursing intervention (p < 0.05). The incidence of postoperative wound complications was decreased, and patient satisfaction was significantly improved (p < 0.05). The Hamilton Anxiety Scale, Hamilton Depression Scale and visual analogue scale scores of the study group were significantly lower than those of the control group, and the Short Form 36 Health Survey Questionnaire scores were higher than those of the control group (p < 0.05). A comprehensive nursing intervention can significantly reduce the incidence and degree of pressure ulcers, accelerate recovery time, reduce postoperative wound complications and improve the quality of life and satisfaction of patients undergoing prone orthopaedic surgery.

Influences of evidence-based nursing intervention on pressure ulcers in intensive care units: A meta-analysis

A meta-analysis was conducted comprehensively to investigate the impact of evidence-based nursing (EBN) interventions on pressure injury (PI) in the intensive care unit (ICU) patients. Computer searches were performed, from databases inception to November 2023, in Wanfang, PubMed, China National Knowledge Infrastructure, Google Scholar, Embase, and Cochrane Library for randomized controlled trials (RCTs) on the application of EBN interventions in ICU patients. Two independent researchers conducted screenings of the literature, extracted data, and carried out quality evaluations. Stata 17.0 software was employed for data analysis. Overall, 25 RCTs, involving 2494 ICU patients, were included. It was found that compared to conventional care methods, the implementation of EBN interventions in ICU patients markedly decreased the occurrence of PI (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.17-0.30, p < 0.001), delayed the onset time of pressure ulcers (standardized mean difference [SMD]: -1.61, 95% CI: -2.00 to -1.22, p < 0.001), and also improved nursing satisfaction (OR: 1.18, 95% CI: 1.14-1.23, p < 0.001). Our findings suggest the implementation of EBN interventions in the care of PI in ICU patients is highly valuable, can reduce the occurrence of PI, can delay the time of appearance, and is associated with relatively higher nursing satisfaction, making it worthy of promotion.

Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis

BACKGROUND

Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting.

OBJECTIVE

The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services.

METHOD

This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale."

FINDINGS

In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale.

CONCLUSION

The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.

Pressure ulcer prevention in practice

Pressure ulcer avoidance in the context of care has the potential to improve the quality and longevity of lives for those living in residential and non-residential care home settings. This paper reports on an educational intervention in the North East of England, which focused on the initial benchmarking of self-reported knowledge levels of healthcare workers, who regularly work with people living within this context. Using a longitudinal study design, a series of three questionnaires were used to collate data from research participants. The study revealed a disparity between what healthcare workers perceived their knowledge to be versus what it was, in terms of application to practice at the front line of patient care. The study reveals that confidence levels in dealing with pressure ulceration had been significantly altered by the training session that was being implemented. It also raised concerns on the methodological approaches being used in the education and training of care staff, which should ideally lead them to be proactive with patients in their care. The study provides an insight into the need for a strategic and targeted approach to pressure ulceration avoidance education, which is tailored to individual learning needs through supervision and mentorship as part of clinical education.

A case report of the treatment and care of decubitus ulcers in macaques with spinal cord injury

Decubitus ulcers are a common spinal cord injury (SCI) complication that puts patients' lives in danger and has emerged as a more prevalent issue in modern clinical rehabilitation and care. Decubitus ulcers in humans can currently be treated in a number of different ways, but there are fewer studies on how to treat and care for decubitus ulcers in macaques. To treat a 20-year-old adult male macaque monkey with SCI and decubitus ulcers after a quarter transection of the thoracic spinal cord, a number of scientific care procedures and pharmaceutical treatments, such as dietary changes and topical or intravenous administration of medication, were carried out and continuously monitored in real-time. In comparison to the untreated group, we observed a significant improvement in decubitus wound healing in the macaques. In this article, we provide a good protocol for decubitus ulcer care after SCI and suggest that future experimental animal modeling needs to focus on issues such as care for postoperative complications.

A Prospective Study of Pressure Injury Healing Rate and Time and Influencing Factors in an Acute Care Setting

OBJECTIVE

To determine pressure injury (PI) healing rate and time and identify influencing factors.

METHODS

A prospective cohort research design was used. Data collection was performed between May 2015 and August 2018. The study participants were 77 inpatients who developed at least one PI during their stay in a university hospital. Researchers assessed participants' demographic (age, sex); physical (incontinence, activity of daily living, and nutrition status); physiologic (serum total protein, albumin, and creatinine, blood glucose, and hemoglobin levels); and disease- (diagnosis, number of comorbidities, and cardiovascular comorbidity), wound- (PI stage and size at first detection, and Pressure Ulcer Scale for Healing score), and treatment-related (IV nutrition supply and albumin infusion) factors.

RESULTS

Across the 77 patients, 91 PIs developed. Of these, 54 (59.3%) healed with a mean healing time of 17.63 days. The healing rate was better, and the healing time was shorter for stage 2 PIs compared with unstageable or deep-tissue PIs. Factors influencing PI healing rate were number of comorbidities, cardiovascular comorbidity, incontinence, PI stage at first detection, IV nutrition supply, and mean serum creatinine level. Factors influencing PI healing time were number of comorbidities, cardiovascular comorbidity, and PI stage at first detection.

CONCLUSIONS

To reduce hospital stays, PI-related complications, and mortality, evidence-based management strategies for PIs are needed. The findings of the present study may contribute to the development of such strategies.

Application Value of Management Model Based on “Zero Tolerance” Concept in Pressure Ulcer Management

Background

Pressure injuries are the most prevalent health problem worldwide. Improving the quality of hospital pressure injury management is an important indicator to improve the quality of hospital management.

Objective

To explore the application value of the management model centered on the concept of “zero tolerance” in the management of pressure ulcers (PU).

Methods

The effects of conventional management mode and management mode centered on the concept of “zero tolerance” on PU patients and nursing staff were retrospectively analyzed. The patients were evaluated by the general comfort questionnaire (GCQ), Generic Quality of Life Inventory 74 (GQOL-74), and pressure ulcer healing scale (PUSH). At the same time, the satisfaction of PU patients and nursing staff with different management modes was investigated.

Results

When comparing the conditions of patients under different management modes, it was found that the “zero tolerance” management mode can improve the comfort and quality of life of patients during hospitalization. Compared with the conventional management mode, the “zero tolerance” management mode can significantly improve the degree of pressure ulcer healing in patients. In addition, the “zero tolerance” management model can not only improve the satisfaction of patients with management but also improve the satisfaction of nursing staff with management.

Conclusion

Standardized management of PU patients with the concept of “zero tolerance” as the core can improve the health status and quality of life of patients, promote wound healing, and improve the satisfaction of patients and nurses with the management plan.

Biomechanical Changes on the Typical Sites of Pressure Ulcers in the Process of Turning Over from Supine Position: Theoretical Analysis, Simulation, and Experiment

Pressure ulcers are mainly caused by prolonged pressure on local tissues. The current method of preventing pressure ulcers is mainly to change the patient's position by turning, so it is significant to study the biomechanics of the typical site of pressure ulcers. Based on anatomical theory, a three-dimensional model of the shoulder and hip was established, and the theoretical contact pressure between the body and the bed was calculated by force analysis. Then, finite element models of typical parts of pressure ulcers were established, and the maximum stresses under different boundary conditions were obtained by finite element analysis. Finally, a human body turning experiment was conducted using a pressure distribution sensor, and the pressure distribution clouds and maximum contact pressure curves under different turning angles were obtained. The results show that the extreme point of maximum stress occurs at [Formula: see text], producing a stress concentration phenomenon; the peak stresses at the shoulder and hip are more balanced in the angular threshold range of [Formula: see text] to [Formula: see text], the stresses are more dispersed, and there exists an angular threshold for optimal integrated pressure, which can improve the efficiency of the use of assisted turning equipment. The relevant results help to explain the causes of pressure ulcer disease and can provide clinical references to improve the effectiveness of care.

Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room

Pressure ulcers are a common complication of immobility and frequently occur in surgical patients. The occurrence of pressure ulcers is affected by many factors, such as operation time and position, anesthesia method, and postoperative nursing. The aim of this study was to investigate the Munro Pressure Ulcer Risk Assessment Scale's value in predicting acute pressure ulcers in general anesthesia patients. This case-control study included patients who underwent more than 2 hours of general anesthesia in our hospital from January 2018 to December 2020. The case group comprised 42 patients who had pressure sores in surgical compression sites within 3 days after surgery. The control group consisted of 84 patients without acute pressure sores after surgery. Baseline patient data were compared between the two groups, and a logistic multivariate model was used to analyze potential risk factors for acute pressure ulcers. The Munro Pressure Ulcer Risk Assessment Scale scores and Braden scale scores were compared between the two groups during and after surgery. A receiver operating characteristic curve was used to evaluate the clinical value of the two scales (administered at the two time points) in predicting the occurrence of acute pressure ulcers after surgery. The operation and anesthesia times of patients in the case group were longer than those in the control group (P < 0.05). The proportion of comatose patients and patients with diabetes were significantly higher in the case group. While the case group had higher Munro scores during and after surgery compared to the control group (P < 0.05), Braden scores at the corresponding time points were lower (P < 0.05). The following variables were identified as independent risk factors of acute pressure ulcers: prolonged operation time and anesthesia time, increase in Munro scores during and after operation, decrease in Braden scores during and after operation, and comatose status (P < 0.05). The area under the receiver operating characteristic curve (AUC) of the postoperative Munro score for predicting postoperative pressure ulcer risk was 0.774; the sensitivity and specificity were 67.73% and 80.58%, respectively. The AUC of the intraoperative Braden score for predicting postoperative pressure ulcer risk was 0.836, with a sensitivity of 78.95% and specificity of 78.00%. The AUC of the postoperative Braden score for predicting postoperative pressure ulcer risk was 0.809, with a sensitivity of 73.58% and specificity of 64.26% (P < 0.05). Our results indicate that the intraoperative Munro Pressure Ulcer Risk Assessment Scale is highly effective for predicting the risk of postoperative pressure ulcers in surgical patients who require general anesthesia.

Effect Evaluation of Platelet-Rich Plasma Combined with Vacuum Sealing Drainage on Serum Inflammatory Factors in Patients with Pressure Ulcer by Intelligent Algorithm-Based CT Image

This work was to explore the efficacy of intelligent algorithm-based computed tomography (CT) to evaluate platelet-rich plasma (PRP) combined with vacuum sealing drainage (VSD) in the treatment of patients with pressure ulcers. Based on the u-net network structure, an image denoising algorithm based on double residual convolution neural network (Dr-CNN) was proposed to denoise the CT images. A total of 84 patients who were hospitalized in hospital were randomly divided into group A (without any intervention), group B (PRP treatment), group C (VSD treatment), and group D (PRP+VSD treatment). Procalcitonin (PCT) was detected by enzyme-linked immunosorbent assay (ELISA) combined with immunofluorescence method, C-reactive protein (CRP) was detected by rate reflectance turbidimetry (RRT), and interleukin-6 (IL-6) was detected by electrochemiluminescence method. The results showed that after treatment, 44 cases (52.38%) of pressure ulcers patients recovered, 24 cases (28.57%) had no change in stage, and 16 cases (19.04%) developed pressure ulcers. The pain scores of group D at 1 week (3.35 ± 0.56 points) and 2 weeks (2.76 ± 0.55 points) after treatment were significantly lower than those in group C (7.77 ± 0.58 points and 6.34 ± 0.44 points, respectively). The time of complete wound healing in group D (24.5 ± 2.32) was obviously lower in contrast to that in groups A, B, and C (35.54 ± 3.22 days, 30.23 ± 2 days, and 29.34 ± 2.15 days, respectively). In addition, the medical satisfaction of group D (8.74 ± 0.69) was significantly higher than that of groups A, B, and C (4.69 ± 0.85, 5.22 ± 0.31, and 5.18 ± 0.59, respectively). The levels of IL-6 and PCT in group D were lower than those in groups A, B, and C, and the differences were statistically significant (P < 0.01). The average values of peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM) of the Dr-CNN network model were 37.21 ± 1.09 dB and 0.925 ± 0.01, respectively, which were higher than other algorithms. The mean values of root mean square error (MSE) and normalized mean absolute distance (NMAD) of the Dr-CNN network model were 0.022 ± 0.002 and 0.126 ± 0.012, respectively, which were significantly lower than other algorithms (P < 0.05). The experimental results showed that PrP combined with VSD could significantly reduce the inflammatory response of patients with pressure ulcers. PRP combined with VSD could significantly reduce the pain of dressing change for patients. Moreover, the performance model of image denoising algorithm based on double residual convolutional neural network was better than other algorithms.

Characteristics of Hospital Acquired Pressure Ulcer and Factors Affecting Its Development: A Retrospective Study

Background Worldwide, pressure ulcers (PUs) have been implicated in costing billions annually, with 60,000 deaths out of 2.5 million hospitalized patients resulting from complications related to PU. The prevention of PU reduces the incidence of other illnesses, decreases the financial costs, and improves the quality of life for patients. We aimed to identify the most influential factors that increased the risk of developing PUs among hospitalized patients at a university hospital according to the Waterlow scale. Methods Data were collected retrospectively from patients who developed PUs between January 2016 and December 2018 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were evaluated using the Waterlow PU risk assessment tool. The analysis was performed using the Statistical Package for Social Science (SPSS), version 23.0 (IBM, Armonk, NY). Results A total of 272 cases were included in this study. The highest number of cases (n = 83, 30.5%) belonged to the age group of 50 to 64 years. The majority of patients had stage 2 PUs (165, 60.7%). The most frequent location of PU was the "back" (97, 35.7%). A history of undergoing major surgery was significantly associated with a higher stage of PU (p = 0.040). The mean Waterlow PU score for all cases was 27.19 ± 13.143. There was a moderate positive correlation between the neurological deficit score and the Waterlow PU score (correlation coefficient: 0.447, p < 0.001). Multinomial logistic regression analysis revealed that increasing age is a significant predictive factor for developing higher stages of PUs (p = 0.046). Conclusion Major surgery, neurological deficit, low hemoglobin level, and increasing age were strong predictors for developing higher stages of PU. Therefore, healthcare contributors should consider these risks when applying a comprehensive PU management plan.

The efficacy of gelatin sponge combined with moist wound-healing nursing intervention for the treatment of pressure ulcers: A randomized controlled trial protocol

OBJECTIVE

The objective of this current research is to investigate the effectiveness of the nursing intervention of combination gelatin sponge and moist wound healing in treating the pressure ulcers (PUs).

METHODS

This is a randomized controlled trial to be carried out from January 2021 to May 2021. This trial is implemented in accordance with the SPIRIT Checklist for the randomized researches and was granted through the Ethics Committee of 5th Medical Center of Chinese PLA General Hospital (No. 0624876). This study includes 80 PU participants. The patients meet the following criteria will be included. All participants meet the diagnostic criteria recommended via the National Pressure Ulcer Advisory Panel Society: complete skin defect, no bones, tendons and muscles exposure, no subcutaneous tunnel or scale; the patients selected are between 40 and 60 years old. The patients with the following criteria will be excluded: receiving other treatments that may influence the healing, for instance, radiation therapy and corticosteroids; patients with the complications of infection, malignant tumors, as well as peripheral vascular disease; and patients with serious diseases, containing kidney, cardiac, and liver diseases. The patients are randomly divided into 2 groups, the control group and study group, with 40 members in each group. In control group, the patients are given the routine nursing care. And in study group, the patients are given the nursing of gelatin sponge combined with moist wound-healing. After 28 days, the state of the patients healing is observed closely, containing the dressing change frequency, curative effects, and the end-point efficiency. On the basis of the Pressure Ulcer Healing Scale developed by the American pressure sore expert group, the quantitative scoring can be implemented, and therapeutic effects are assessed.

RESULTS

The variables of clinical result among the groups are illustrated in the Table.

CONCLUSION

The nursing intervention of gelatin sponge combined with the moist wound- healing may evidently increase the healing efficiency of PU.

TRIAL REGISTRATION NUMBER

researchregistry 6091.