Pressure ulcer predictors in ICU patients: nursing skin assessment versus objective parameters

Compton, Friederike; Hoffmann, Falko; Hortig, T; Strauss, Maurice B.; Frey, J; Zidek, Walter; Schäfer, Jürgen-Heiner

doi:10.12968/jowc.2008.17.10.31304

Cited by 71 publications

(97 citation statements)

References 22 publications

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“…Current scales for determining the risk for pressure ulcers do not accurately indicate the complexity of the patient's risk, life-saving devices, and comorbid conditions that lead to the development of pressure ulcers. 6,16,17,20,21 Multiple studies of various risk factors for development of pressure ulcers in critically ill patients have been done. In a systematic review, Coleman et al 20 found that no single factor explained the development of the ulcers.…”

Section: Discussionmentioning

confidence: 99%

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit

Bly

Schallom

Sona

et al. 2016

American Journal of Critical Care

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This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: Background Although most intensive care patients are at risk for pressure ulcers, not all experience such ulcers.Objective To examine a model of variables related to extrinsic and intrinsic pressure on skin and underlying tissues, oxygenation, perfusion, and baseline comorbid conditions to identify risk factors associated with pressure ulcers in critically ill adults. Method A retrospective chart review was conducted on patients identified by weekly rounds from January 2010 through October 2010 to determine the prevalence of pressure ulcers. Variables were analyzed via bivariate analysis and logistic regression for unit-acquired pressure ulcers. Results Data on 345 patients with 436 intensive care admissions were reviewed. Variables were significant in each model category at P < .05. In the regression analysis of first admission only (n = 306), the model was significant (P < .001) and yielded correct classification of 86.3% of patients. For all intensive care admissions (n = 391), the model was significant (P < .001) and yielded correct classification of 83.9% of patients. In both models, 4 of the same variables were significant: any transport off the unit, number of days to bed change, systolic blood pressure less than 90 mm Hg, and use of more than 1 vasopressor. History of pulmonary disease and presence of a feeding tube were also significant in regression analyses. Conclusions Several variables within the model of pressure, oxygenation, and perfusion were significantly associated with development of pressure ulcers.

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Section: Discussionmentioning

confidence: 99%

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit

Bly

Schallom

Sona

et al. 2016

American Journal of Critical Care

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“…In other studies, 16,17 relationships between vasopressor administration and development of pressure ulcers was significant; however, the specific vasopressors used were not identified. In still other studies, the specific vasopressors were indicated, but a generic variable was used for analysis, yielding significant relationships with development of pressure ulcers in both multivariate 18 and univariate 19 analyses. In 2 studies with multivariate analyses, 20,21 norepinephrine was significantly associated with development of pressure ulcers, whereas in another study, 22 moderate doses of norepinephrine were significantly related to development of pressure ulcers.…”

Section: Review Of the Relevant Literaturementioning

confidence: 99%

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Cox

Roche

2015

American Journal of Critical Care

112

103

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Background Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. Objective To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. Methods A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. Results Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. Conclusion The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.

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“…Duration of mechanical ventilation is also associated with increased risk of pressure ulcer development. [20][21][22] Variables in acuity in ICUs and lack of definitive studies addressing use of mechanical ventilation, vasoactive medi cations, and mobility affect the results in studies of pressure ulcer development. Even if the opinion is that a particular scale overestimates risk, it still identifies that the patient is at risk and encourages the use of preventive measures to prevent pressure ulcers from developing.…”

Section: Pressure Ulcer Risk Assessment Scalesmentioning

confidence: 99%

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

Cooper

2013

Critical Care Nurse

118

112

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T he development of hospital-acquired pressure ulcers is a great concern in health care today. Pressure ulcer treatment is costly, and the development of pressure ulcers can be prevented by the use of evidence-based nursing practice. In 2008, the Centers for Medicare and Medicaid Services announced that they will not pay for additional costs incurred for hospital-acquired pressure ulcers.1 The development of a stage III or IV pressure ulcer is now considered a "never event."2 This change has resulted in an increased focus on preventive strategies and institutional scrutiny of pressure ulcers that develop in patients after hospital admission. The cost of 1 stage III or IV pressure ulcer may be between $5000 and $50000. 2The actual cost of pressure ulcers is not known because it is unclear what costs were included in estimates, such as nursing care costs, material costs, and added acute care days related to the development of a pressure ulcer. 3 In the intensive care unit (ICU), patients have multiple factors that increase the risk of pressure ulcers developing. Typically the patient has respiratory equipment, urinary catheters, sequential compression devices, multiple intravenous catheters, and the infusion of vasoactive agents for hypotension that may contribute to inability to turn patients and increase the risk of pressure ulcer development. This article discusses the multiple risk factors present in critical care for the development of pressure ulcers, current practices, and evidence for interventions aimed at preventing pressure ulcers.

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Pressure ulcer predictors in ICU patients: nursing skin assessment versus objective parameters

Abstract: Nursing skin assessment is an important pressure ulcer risk stratification tool in the ICU despite the availability of a large number of objectively measureable ICU specific parameters in these patients.

Cited by 71 publications

References 22 publications

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

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