Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation

Intensive and Critical Care Nursing

Munro

Wetzel

et al. 2017

Summary Objective To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations. Design, setting, patients Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24 hours of intubation. Measurements Tissue interface pressure was measured continuously using the XSENSOR pressure mapping system (XSENSOR Technology Corporation, Calgary, Canada). Skin integrity was observed at all sites, twice daily, using the National Pressure Ulcer Advisory Panel staging system, for the first seven ICU days and at day 10 and 14. Results Of the 132 subjects, 90.9% had no observed changes in skin integrity. Maximum interface pressure was above 32 mmHg virtually 100% of the time for the sacrum, left and right trochanter. At the 45 mmHg level, the left and right trochanter had the greatest amount of time above this level (greater than 95% of the time), followed by the sacrum, left and right scapula, and the left and right heels. Similarly, at levels above 60 mmHg, the same site order applied. For those six subjects with sacral skin integrity changes, maximum pressures were greater than 32 mmHg100% of the time. Four of the six sacral changes were associated with greater amounts of time above both 45 mmHg and 60 mmHg than the entire sample. Conclusions Maximum tissue interface pressure was above critical levels for the majority of the documented periods, especially in the sacrum, although few changes in skin integrity were documented. Time spent above critical levels for mean pressures were considerably less compared to maximum pressures. Maximum pressures may have reflected pressure spikes, but the large amount of time above the critical pressure levels remains substantial.

Section: Introductionmentioning

confidence: 72%

Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients

Intensive and Critical Care Nursing

Munro

Wetzel

et al. 2017

“…20 Subjects were enrolled in the study within 24 h of intubation, and sacral images were obtained daily for up to 7 days. Data were collected from February 2010 to May 2012.…”

Section: Sample and Settingmentioning

confidence: 99%

High-Frequency Ultrasound: Obtaining Optimal Images and the Effect of Image Artifacts on Image Quality

Burk

Lucas

et al. 2017

Advances in Wound Care

Objective: High-frequency ultrasound (HFUS) images are being researched for use in the prevention, detection, and monitoring of pressure injuries in patients at risk. This seminal longitudinal study in mechanically ventilated adults describes image quality, the incidence of image artifacts, and their effect on image quality in critically ill subjects. Approach: Mechanically ventilated subjects from three adult intensive care units were enrolled, and multiple sacral images from each subject were obtained daily. Using a subset of best image per patient per day, artifacts were grouped, and their effect on image quality was statistically evaluated.

“…This secondary analysis of data from a larger study, 22 compared sacral HFUS tissue characteristics (dermal thickness and dermal density) with visual examination of the sacral HFUS image over multiple day-to-day comparisons, up through study day 7 for 113 critically ill subjects. We found no association among dermal density, dermal thickness and visual examination of changes in sacral HFUS images for any day-to-day comparison.…”

Section: Discussionmentioning

confidence: 99%

“…22 The study was approved by the university Institutional Review Board (IRB) and informed consent was obtained from the subject’s legally authorized representative (LAR). Because the parent study included use of a pressure mapping system that may enhance skin moisture, exclusion criteria included patients who had significant skin moisture risk as determined by the Braden scale of “constantly moist”.…”

Section: Methodsmentioning

confidence: 99%

“…19–21 However, there are no data that compare changes in these tissue characteristics (dermal thickness and dermal density) to changes found using visual evaluation of the HFUS scan to determine the usefulness of these HFUS objective tissue measures for early identification of tissue injury. Therefore this secondary analysis of data from a larger study, 22 will compare sacral HFUS tissue characteristics (dermal thickness and dermal density) with visual examination of the HFUS image.…”

mentioning

confidence: 99%

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High frequency ultrasound sacral images in the critically ill: Tissue characteristics versus visual evaluation

Intensive and Critical Care Nursing

Schubert

Burk

et al. 2017

Purpose High frequency ultrasound (HFUS) systems may identify tissue injury. We compared HFUS tissue characteristics (dermal thickness and dermal density) with visual image examination. Methods Longitudinal study in critically ill mechanically ventilated adults, from 3 ICUs (Surgical Trauma, Medical Respiratory, Neuroscience) enrolled within 24 hours of airway intubation. Sacral HFUS images were obtained daily for up to 7 days. Expert evaluation of the best image per day was completed and compared to HFUS generated tissue characteristics (dermal thickness and dermal density). Results Of the113 subjects with 1614 comparisons analyzed, 73.2% to 84% were normal, and 6.3% to 11.8% of the comparisons had injury present but no change was noted in the injury observed. There were no significant differences in one-day comparisons among type of injury and mean dermal thickness (p = 0.6645) or dermal median intensity (adjusted p = 0.06–0.17). All other day-to-day comparisons were similarly non-significant. Conclusions We found no association among dermal density, dermal thickness and visual examination of changes in sacral HFUS images for any day-to-day comparison. The use of sacral HFUS as a screening tool for the development of tissue injury is in its infancy. Additional comparative studies should be conducted to identify its future clinical usefulness.