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Woolger C, Rollinson T, Oliphant F, Ross K, Ryan B, Bacolas Z, Burleigh S, Jameson S, McDonald LA, Rose J, Modra L, Costa-Pinto R. Pressure injuries in mechanically ventilated COVID-19 patients utilising different prone positioning techniques - A prospective observational study. Intensive Crit Care Nurs 2024; 82:103623. [PMID: 38215559 DOI: 10.1016/j.iccn.2024.103623] [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: 09/11/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To compare the incidence and distribution of pressure injuries (PIs) with two approaches to prone positioning for mechanically ventilated COVID-19 patients, and to determine the prevalence of these PIs on intensive care unit (ICU) and hospital discharge. DESIGN A prospective observational study. SETTING Adult patients admitted to a quaternary ICU with COVID-19-associated acute lung injury, between September 2021 and February 2022. MAIN OUTCOME MEASURES Incidence and anatomical distribution of PIs during ICU stay for "Face Down" and "Swimmers Position" as well as on ICU and hospital discharge. RESULTS We investigated 206 prone episodes in 63 patients. In the Face Down group, 26 of 34 patients (76 %) developed at least one PI, compared to 10 of 22 patients (45 %) in the Swimmers Position group (p = 0.02). Compared to the Swimmers Position group, the Face Down group developed more pressure injuries per patient (median 1 [1, 3] vs 0 [0, 2], p = 0.04) and had more facial PIs (p = 0.002). In a multivariate logistic regression model, patients were more likely to have at least one PI with Face Down position (OR 4.67, 95 % CI 1.28, 17.04, p = 0.02) and greater number of prone episodes (OR 1.75, 95 % CI 1.12, 2.74, p = 0.01). Over 80 % of all PIs were either stage 1 or stage 2. By ICU discharge, 29 % had healed and by hospital discharge, 73 % of all PIs had healed. CONCLUSION Swimmers Position had a significantly lower incidence of PIs compared to the Face Down approach. One-quarter of PIs had healed by time of ICU discharge and three-quarters by time of hospital discharge. IMPLICATIONS FOR CLINICAL PRACTICE There are differences in incidence of PIs related to prone positioning approaches. This study validates and helps better inform current prone position guidelines recommending the use of Swimmers Position. The low prevalence of PIs at hospital discharge is reassuring.
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Affiliation(s)
- Cara Woolger
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Thomas Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Department of Physiotherapy, the University of Melbourne, Parkville, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Fiona Oliphant
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Kristy Ross
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Brooke Ryan
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Zoe Bacolas
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Sarah Burleigh
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Stephanie Jameson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Department of Physiotherapy, the University of Melbourne, Parkville, Victoria, Australia
| | - Luke A McDonald
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Joleen Rose
- Department of Physiotherapy, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Lucy Modra
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia.
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2
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Corona-Rodarte E, Cano-Aguilar LE, Baldassarri-Ortego LF, Tosti A, Asz-Sigall D. Pressure alopecias: A review. J Am Acad Dermatol 2024; 90:125-132. [PMID: 37454698 DOI: 10.1016/j.jaad.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Pressure-induced alopecias (PAs) are an infrequent group of scarring and nonscarring alopecias that occur after ischemic obstruction of capillaries that leads to circumscribed areas of hair loss. Initially described after prolonged surgeries or immobilization, type 1 PA occurs after sustained external pressure to the skin, mainly the scalp prominences. Alopecia induced by cosmetic procedures, referred in this review as type 2 PA, is reported with increased frequency in literature and predominantly emerges from pressure exerted by the volume of injectables. It is important to differentiate type 2 PA from vascular occlusion-induced alopecia because they represent distinct entities. Clinically, PA may present with erythema, swelling, and tenderness; however, alopecia might be the sole manifestation. Crusts and ulceration are associated with a worse outcome and a higher risk of scarring alopecia. Prompt diagnosis is paramount to prevent complications. Trichoscopy, although considered nonspecific, may provide relevant clues for an accurate diagnosis. Hair regrows in most cases, but prognosis depends on ischemia severity and timely treatment with reperfusion therapies or mobilization. Treatment of hair loss is usually not necessary because the disease in most cases is self-limited and reversible. The role of topical minoxidil and corticosteroids remains unknown.
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Affiliation(s)
- Eduardo Corona-Rodarte
- Department of Dermatology, Instituto Dermatológico de Jalisco José Barba Rubio, Zapopan, Mexico.
| | | | | | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Asz-Sigall
- Trichology Clinic, Department of Dermatology, Hospital General "Dr. Manuel Gea González," Mexico City, Mexico.
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3
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Hughes PJ. Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit. J Wound Ostomy Continence Nurs 2023; 50:458-462. [PMID: 37966074 DOI: 10.1097/won.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE The purpose of this quality improvement (QI) initiative was to evaluate the effects of a repositioning intervention bundle on the occurrences and severity of hospital-acquired pressure injuries (HAPIs) of the face in patients with COVID-19-related acute respiratory distress syndrome (ARDS) managed by ventilation and placed in a prone position. PARTICIPANTS AND SETTING Eighteen critically ill, ventilated patients were placed in a prone position for extended periods (range, 1-13 days). The study setting was critical care units in a 504-bed nonprofit teaching hospital located in the Northeastern United States. APPROACH Standard of care for the prevention of pressure injury (PI) in ventilated patients placed in a prone position at our facility included use of foam dressings over bony prominences on the face and the application of tape to secure the endotracheal (ET) tube as compared to commercial ET tube securement devices. We also placed a fluidized pillow with pillowcase wrapped with an absorbent pad under the head to absorb secretions. We added 2 interventions to our facility's existing HAPI prevention bundle. The first was a repositioning strategy; ventilated and prone patients were lifted by their shoulders by critical care RNs while their ET tube was stabilized by a respiratory therapist every 6 hours. The RNs then repositioned the patient's head and arms to the opposite side into a swimmer's position (head lying to the side with one cheek in contact with the fluidized pillow). The second intervention was micromovement of the head performed by an RN every 4 hours. OUTCOMES Prior to implementation of the QI initiative, data collected during the early pandemic demonstrated that multiple patients developed facial PIs secondary to prone positioning; a majority were full-thickness or unstageable PIs, whereas a minority were partial-thickness PIs (stage 2). Following implementation of the QI initiative, data indicated that 5 of 18 (28%) patients placed in a prone position had HAPIs of the face; 4 (22%) of the HAPIs were stage 1 or 2 and 1 was unstageable. Patients were placed in a prone position from 1 to 13 days. All facial HAPIs developed within the first 2 days of placement in a prone position. IMPLICATIONS FOR PRACTICE The addition of an RN and a respiratory therapist repositioning intervention and micromovements of the head every 4 hours by the RN to an existing pressure prevention bundle during prone positioning led to a clinically relevant reduction in the severity of facial HAPIs. As a result, care for these patients has been changed to incorporate the repositioning interventions implemented during this QI project.
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Affiliation(s)
- Pamela J Hughes
- Pamela J. Hughes, MSN, MBA, RN, CWOCN, CNL, Overlook Medical Center, Westfield, New Jersey
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4
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; 36:421-434. [PMID: 37471447 DOI: 10.1097/asw.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization." STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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5
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Ruhland J, Dähnert E, Zilezinski M, Hauss A. Pressure Injury Prevention in Patients in Prone Position With Acute Respiratory Distress Syndrome and COVID-19. Crit Care Nurse 2023; 43:46-54. [PMID: 37001876 DOI: 10.4037/ccn2023559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introduction
In patients with acute respiratory distress syndrome, prone positioning improves oxygenation and reduces mortality. Pressure injuries occur frequently because of prolonged prone positioning in high-risk patients, and preventive measures are limited. This article describes 2 patients who developed minimal pressure injuries despite several prone positionings. Prevention strategies are also described.
Clinical Findings
A 64-year-old man and a 76-year-old woman were admitted to the hospital with respiratory insufficiency. Due to acute respiratory distress syndrome, both patients were intubated and received mechanical ventilation and prone positioning.
Diagnosis
Both patients had positive test results for SARS-CoV-2 and a diagnosis of acute respiratory distress syndrome.
Interventions
Patient 1 was in prone position for 137 hours during 9 rounds of prone positioning; patient 2, for 99 hours during 6 rounds of prone positioning. The standardized pressure injury prevention bundle for prone positioning consisted of skin care, nipple protection with a multilayer foam dressing, a 2-part prone positioning set, and micropositioning maneuvers. For both patients, 2-cm-thick mixed-porosity polyurethane foam was added between skin and positioning set in the thoracic and pelvic areas and a polyurethane foam cushion was added under the head.
Outcomes
Patient 1 developed no pressure injuries. Patient 2 developed category 2 pressure injuries on the chin and above the right eye during deviations from the protocol.
Conclusion
For both patients, the additional application of polyurethane foam was effective for preventing pressure injuries. These case reports support the addition of polyurethane foam to prevent pressure injuries in patients placed in the prone position.
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Affiliation(s)
- Julia Ruhland
- Julia Ruhland is a registered nurse in a COVID-19 intensive care unit, Department of Nephrology and Medical Intensive Care, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Germany
| | - Enrico Dähnert
- Enrico Dähnert is a registered nurse and practice development manager for nursing, Business Division Nursing Directorate, Nursing Science, Charité, Universitätsmedizin Berlin
| | - Max Zilezinski
- Max Zilezinski is a registered nurse and research associate, Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
| | - Armin Hauss
- Armin Hauss is a registered nurse, research associate, and quality improvement manager, Business Division Nursing Directorate, Nursing Science and Institute for Clinical Nursing Science, Charité, Universitätsmedizin Berlin
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6
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Putri IL, Tungga AAA, Pramanasari R, Wungu CDK. Characteristics of Patients with Pressure Injuries in a COVID-19 Referral Hospital. Adv Skin Wound Care 2023; 36:1-6. [PMID: 36940381 DOI: 10.1097/01.asw.0000919956.83713.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the characteristics of patients treated at a COVID-19 referral hospital from March 2020 to June 2021 who experienced pressure injuries (PIs) either before or after admission. METHODS The researchers collected and analyzed data on patients' demographic characteristics, symptoms, comorbidities, location and severity of PI, laboratory values, oxygen therapy, length of stay, and vasopressor use. RESULTS During the study period, 1,070 patients were hospitalized for COVID-19 with varying degrees of severity, and 12 patients were diagnosed with PI. Eight (66.7%) of the patients with PI were men. The median age was 60 (range, 51-71) years, and half of the patients had obesity. Eleven of the patients with PI (91.4%) had at least one comorbid condition. The sacrum and gluteus were the two most commonly affected sites. Those with stage 3 PI had a substantially greater median d-dimer value (7,900 ng/mL) than patients with stage 2 PI (1,100 ng/mL). The average length of stay was 22 (range, 9.8-40.3) days. CONCLUSIONS Health professionals should be aware of an increase in d-dimer in patients with COVID-19 and PI. Even though PIs in these patients might not result in mortality, an increase in morbidity can be avoided with the right care.
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Affiliation(s)
- Indri Lakhsmi Putri
- Indri Lakhsmi Putri, MD, PhD, is Plastic Surgeon, Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia, and Craniofacial Consultant, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University. Also at Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Aldrich Alexander Afeli Tungga, MD, is Surgical Intern, and Rachmaniar Pramanasari, MD, is Plastic Surgeon. In the Faculty of Medicine at Airlangga University, Citrawati Dyah Kencono Wungu, MD, PhD, is Medical Staff, Department of Physiology and Medical Biochemistry
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7
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; Publish Ahead of Print:00129334-990000000-00021. [PMID: 36705972 DOI: 10.1097/01.asw.0000919408.20614.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization. STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022
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8
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Seckel MA, Mitchell DA. Securing Endotracheal Tubes During Prone Positioning. Crit Care Nurse 2022; 42:77-79. [PMID: 36180052 DOI: 10.4037/ccn2022354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Maureen A Seckel
- Maureen A. Seckel is a critical care clinical nurse specialist and sepsis coordinator, ChristianaCare, Newark, Delaware
| | - Dannette A Mitchell
- Dannette A. Mitchell is a medical critical care clinical nurse specialist, ChristianaCare, Wilmington, Delaware
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9
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:416-424. [PMID: 36045034 DOI: 10.4037/ajcc2022644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. OBJECTIVE To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. RESULTS Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. CONCLUSIONS Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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10
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Pokorná A, Dolanová D, Benešová K, Búřilová P, Mužík J, Jarkovský J, Krupová L, Baťalík L, Klugarová J, Klugar M. How the COVID-19 pandemic influences the prevalence of pressure injuries in the Czech Republic: A nationwide analysis of a health registry in 2020. J Tissue Viability 2022; 31:424-430. [PMID: 35725785 PMCID: PMC9197563 DOI: 10.1016/j.jtv.2022.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND COVID-19 significantly influences the overall patient status and, in severe symptomatology, the ability to move and the low oxygenation of the tissue for the ventilated patient in Intensive Care Units (ICU). There is a higher risk for Pressure injuries (PIs) development. OBJECTIVES The nationwide analyses of the National health register aimed to compare the prevalence of PIs reported before the pandemic COVID-19 started and during the pandemic in 2020. METHOD A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist collected by the National Health Information System (NHIS), focusing on the PIs reporting based on the International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs in 2020. The data from the pandemic period of COVID-19 in 2020 were compared to the prevalence of PI cases in the period 2010-2019 in the Czech Republic in all hospitalized patients. RESULTS The total number of admissions for L89 in 2020 was 14,441, of which 1509 (10.4%) also had COVID-19. In the ICU were 4386 admissions, 12.1% of which also had COVID-19. A higher proportion of PIs is observed in patients hospitalized with COVID-19 than in patients without COVID-19 (2.62% vs 0.81%, respectively 1.05% vs 0.46% when standardized to the 2013 ESP = European Standard Population). In patients hospitalized in ICU, 3.68% with COVID-19 had PIs vs 1.42% without COVID-19 had PIs (1.97% vs 0.81% using the 2013 ESP). CONCLUSION The national health registers analyses have proven that the prevalence of PIs was higher among patients hospitalized with the SARS-CoV-2 infection.
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Affiliation(s)
- Andrea Pokorná
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, 625 00, Brno, Czech Republic.
| | - Dana Dolanová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic
| | - Klára Benešová
- Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic
| | - Petra Búřilová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic,Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, 625 00, Brno, Czech Republic,Department of Public Health, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic
| | - Jan Mužík
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic
| | - Jiří Jarkovský
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic
| | - Lenka Krupová
- Department of Dermatology, University Hospital Ostrava, 17. Listopadu 1790/5, Ostrava, 708 00, Czech Republic
| | - Ladislav Baťalík
- Department of Public Health, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Department of Rehabilitation, University Hospital Brno, Jihlavska 20, Brno, 625 00, Czech Republic
| | - Jitka Klugarová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic,Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, 625 00, Brno, Czech Republic
| | - Miloslav Klugar
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic,Institute of Health Information and Statistics, Palackého Náměstí 4, Prague, 128 01, Czech Republic,Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, 625 00, Brno, Czech Republic
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11
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Alderden J, Kennerly SM, Cox J, Yap TL. Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Adv Crit Care 2022; 33:173-185. [PMID: 35657764 DOI: 10.4037/aacnacc2022335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
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Affiliation(s)
- Jenny Alderden
- Jenny Alderden is Associate Professor, Boise State University School of Nursing, 1910 University Dr, Boise, ID 83725
| | - Susan M Kennerly
- Susan M. Kennerly is Professor, East Carolina University College of Nursing, Greenville, North Carolina
| | - Jill Cox
- Jill Cox is Clinical Associate Professor, Rutgers University, and Wound, Ostomy, Continence Advanced Practice Nurse, Englewood Health, Newark, New Jersey
| | - Tracey L Yap
- Tracey L. Yap is Associate Professor, Duke University School of Nursing, Durham, North Carolina
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Short and long-term complications due to standard and extended prone position cycles in CoViD-19 patients. Intensive Crit Care Nurs 2021; 69:103158. [PMID: 34895799 PMCID: PMC8554071 DOI: 10.1016/j.iccn.2021.103158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate short and long-term complications due to standard (≤24 hours) and extended (>24 hours) prone position in COVID-19 patients. METHODS Retrospective cohort study conducted in an Italian general intensive care unit. We enrolled patients on invasive mechanical ventilation and treated with prone positioning. We recorded short term complications from the data chart and long-term complications from the scheduled follow-up visit, three months after intensive care discharge. RESULTS A total of 96 patients were included in the study. Median time for each prone positioning cycle (302 cycles) was equal to 18 (16-32) hours. In 37 (38%) patients at least one cycle of extended pronation was implemented. Patients with at least one pressure sore due to prone position were 38 (40%). Patients with pressure sores showed a statistically significative difference in intensive care length of stay, mechanical ventilation days, numbers of prone position cycles, total time spent in prone position and the use of extended prone position, compared to patients without pressure sores. All lesions were low grade. Cheekbones (18%) and chin (10%) were the most affected sites. Follow-up visit, scheduled three months after intensive care discharge, was possible in 58 patients. All patients were able to have all 12 muscle groups examined using theMedical Research Council scale examination. No patient reported sensory loss or presence of neuropathic pain for upper limbs. CONCLUSIONS Extended prone position is feasible and might reduce the workload on healthcare workers without significant increase of major prone position related complications.
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