Incidência de úlcera por pressão em Unidade de Terapia Intensiva

Abstract

Objective: To determine and to analyze pressure ulcers incidence and risk factors, and their relationships with nursing work-load in critical care patients. Methods: As a part of the research project named "Patient safety in intensive care units: the influence of nursing personnel in adverse events occurrence", a retrospective cohort study was taken in nine intensive care units and one semi-intensive care unit in two university hospitals in Sao Paulo. A total of 766 pacients without pressure ulcer 24 hours after their admission in the units were studied. The variables of interest for this study were collected in digitalized records. The statistical analysis were done using cumulative incidence, Pearson´s Chi-Square, Mann-Whitney´s and Logisitic regression (Stepwise Forward) tests. Results: the incidence of pressure ulcers was 18.7%. Patients under mechanical ventilation had a chance 3.5 times higher for developing of pressure ulcer (OR 3.479; IC 95% 2.190-5.528; p < 0.001); being under paliative care augmented 7.8 times the chance for developing pressure ulcer (OR 7.829; IC 95% 1.927-31.817; p = 0.004); for each day more of stay in ICU, the chance of developing pressure ulcers were 10.1% higher (OR 1.101; IC 95% 1.071-1.132; p < 0.001); each point of Nursing Activities Score rose the chance of developing pressure ulcer in 1.5% (OR 1.015; IC 95% 1.003-1.027; p = 0.016); patients between 60 and 84 years-old had a 2.3 higher chance of developing pressure ulcers than patients younger than 45 years-old (OR 2.331; IC 95% 1.283-4.236; p = 0.005) and, after the age of 85, the chance for developing pressure ulcers were 2.7 times higher than in patients younger than 45 years-old (OR 2.695; IC 95% 0.945-7.683; p < 0.064). Conclusion: admitting that pressure ulcers are an adverse effect and that their occurrence is related with poor assistance quality, we can consider the incidence of 18,7% found in this cohort as high. Prevention actions must be enforced to guarantee a decrease in these figures.