Characteristics and risk factors of nasal mucosal pressure injury in intensive care units

Abstract

Aims and Objectives This study aimed to understand the risk factors that contribute to medical device‐related (MDR) nasal mucosal membrane pressure injuries (MM PI) in ICU patients. Background ICU patients require substantial tube‐based life support such as oxygen tubes, tracheal intubation and indwelling gastric tubes. As a result, there is an increased risk of PI occurrence; however, few studies have assessed the risk factors associated with nasal mucosal MDR‐MMPI in ICU patients. Design A cross‐sectional study design was performed. Methods From January 2019 to June 2020, data from 912 patients treated in the ICU of a tertiary first‐class a hospital in China were collected. The occurrence of PI of the nasal mucosa was obtained by nasopharyngoscope when replacing the nasal catheter fixation patch every day. The study methods were followed by the STROBE guidelines. Results The incidence of nasal mucosal MDR‐MM PI was 10.9%. The degree of nasal mucosal MM PI was mainly grade 1 (62cases, 62.6%), and no grade 4 were observed. The columella (58 cases, 58.6%) was the most common site of nasal mucosal MM PI followed by the anterior septum (18 cases, 18.2%). A high patient APACHE‐Ⅱ score, the disturbance of consciousness, a history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and the use of vasoconstrictors were identified as significant influencing factors of nasal MM PI in ICU patients (p < .05). Conclusions A high APACHE‐Ⅱ score, disturbance of consciousness, history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and use of vasoconstrictive drugs were risk factors for nasal mucosal MDR‐MM PI in ICU patients. This study informs on the risk factors of nasal mucosal MM PI that will allow medical support staff to carry out key interventional measures to prevent nasal mucosal MM PI. Relevance to clinical practice This study illustrates the characteristics and risk factors of nasal mucosal pressure injury in intensive care units, potentially contributing to the prevention of the incidence of nasal mucosal MDR‐PI in ICU patients.

Factors associated with facial pressure injury in patients receiving non‐invasive positive pressure ventilation mask: A retrospective case–control study

“…This study showed that a high APACHE-II score was a significant difference between the FPI group and the non-FPI group. Previous studies found that high APACHE-II scores were a contributing factor to medical device-related pressure injury (MDRPI) (Cox & Schallom, 2021;Nan et al, 2022), which was consistent with this study. Nan et al (2022) showed that MDRPI patients in the ICU were positively associated with high APACHE-II scores.…”

“…Previous studies found that high APACHE-II scores were a contributing factor to medical device-related pressure injury (MDRPI) (Cox & Schallom, 2021;Nan et al, 2022), which was consistent with this study. Nan et al (2022) showed that MDRPI patients in the ICU were positively associated with high APACHE-II scores. Thus, higher APACHE-II scores (meaning severe disease state) highlight detrimental changes in patient hemodynamic instability and the potential to worsen dynamic physiologic parameters (Cox & Schallom, 2021).…”

“…Rastogi and Layon (2021) and Jacq et al (2021) showed that high CRP supports FPI; this was consistent with our findings that a high CRP may be associated with FPI. In addition, Nan et al (2022) TA B L E 2 (Continued) may cause vascular, tissue and ischaemic damage through specific mechanisms (Baron et al, 2022). In other words, a common problem resulting from severe systemic infection and its clinical deterioration is pressure injury (Baron et al, 2022).…”

“…Intrinsic risk factors such as age (age is the most common risk factor as a significant predictor); skin thinness due to anatomy and multimorbidity conditions (e.g. diabetes mellitus, cardiovascular disease and hypotension); hypoxia/respiratory failure; disease severity (high APACHE‐II score) (Nan et al, 2022); hypoproteinaemia; protein‐calorie malnutrition or poor hydration; anaemia; infection and fever (T > 37.5°C) (Nan et al, 2022); disability; and lowest total Braden Score (lower scores on the Braden mobility subscale at admission to the ICU predicted the development of pressure injury) (Cox & Schallom, 2021; Dang et al, 2021; Sala et al, 2021). Several extrinsic factors associated with pressure injury include the length of stay or the prolonged stay in the ICU, impaired (reduce) mobility/activity; treatment‐related factors such as use of medications (corticosteroids) (Arai et al, 2020; Jacq et al, 2021) or administration of vasopressor/vasoconstrictor (Nan et al, 2022); prolonged mechanical ventilation; and medical device‐related pressure injury can occur as a result of a multitude of medical devices (Dang et al, 2021; Sala et al, 2021).…”

Model construction of factors influencing intensive care unit nurses' medical device‐related pressure injury knowledge, attitude, and practice

“…The shape of the injury is often consistent with the shape of the medical devices. The prevalence of MDRPI in critically ill patients in the intensive care unit (ICU) is due to the frequent use of various medical devices, extensive drug therapy and patients' own characteristics such as skin edema 7‐10 . It is now one of the more serious adverse events in ICU patients 11,12 .…”