Pressure ulcers in critically ill patients – Preventable by non-sedation? A substudy of the NONSEDA-trial

Nah

Biological Research For Nursing

et al. 2021

Purpose: This study was performed to determine the relationship between oral-mucosal pressure ulcer (PU) stage and mechanical conditions and individual susceptibility in intubated patients. Methods: We collected 80 patient-days data from an intensive care unit of a 700-bed hospital in Korea. We analyzed oral-mucosal PUs, medical records, amount of saliva, and oral mucosal swabs. Bacterial abundance was enumerated by real-time polymerase chain reaction. The χ2 or Fisher’s exact test, t-test or Mann-Whitney U test, and Spearman’s rho correlation analysis were performed. Results: The incidence of overall oral-mucosal PUs was 31.3%, and in the maxillary and mandibular sites were 16.3% and 26.3%, respectively. There were significant correlations between the maxillary site PU stage and restraint use (r = .43, p < .001), albumin level (r = −.22, p = .046), and relative abundance of P. aeruginosa (r = .45, p < .001) and S. aureus (r = −.24, p = .033). In the mandibular sites, there were significant correlations between PU stage and restraint use (r = .30, p = .008), level of consciousness (r = .31, p = .005), and relative abundance of P. aeruginosa (r = .25, p = .028) and S. pneumoniae (r = .22, p = .046). Conclusions: Frequent monitoring and repositioning the mechanical pressure on the oral-mucosa could be an effective preventive strategy against the development and advancement of oral-mucosal PUs. Additionally, monitoring the oral microorganisms can prevent advanced stage oral-mucosal PUs in intubated patients.

Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Relationships Between Oral-Mucosal Pressure Ulcers, Mechanical Conditions, and Individual Susceptibility in Intubated Patients Under Intensive Care: A PCR-Based Observational Study

Nah

Biological Research For Nursing

et al. 2021

“…In a previous study, the use of sedatives was an independent risk factor for the development of PU 11 . A more recent study, however, found no difference in the number of PU diagnosed in the two groups (with and without sedation), although it found that the location of the PU differed between the two groups, and the non-sedated patients had PU mainly related to the medical devices, while sedated patients develop PU mainly on the sacrum and heels 12 .…”

Section: Discussionmentioning

confidence: 89%

The risk of developing Pressure Ulcer and its relation to the patient`s Status and treatment received in na intensive care Unit in Angola.

Pinto¹,

Assunção²,

Alves³

et al. 2021

iNJ

Background: Pressure ulcers (PU) are common in patients in intensive care unit (ICU). Many factors contribute to this which include the patient´s status and the characteristics and type of the treatment applied in this level of care1-3. In Angola, a low-middle-income country, the study of this topic is still incipient, which makes it relevant to know whether the Braden scale score differs significantly in different groups of critical care patient. De Alirio Martinho Belchior para Todos: 10:40 AM Aims: To determine if there is a statistically significant difference between the risk of developing pressure ulcers, and the groups of patients sorted by the severity of their disease, organ function/ rate of failure and type of the treatment applied in the ICU. On this behalf the following variables were established: patients treated with sedatives, vasoactive drugs, mechanical ventilation, haemodialysis; Braden Scale average score, the APACHE II (Acute Physiology and Chronic Health Evaluation) score, the SOFA (Sequential Organ Failure Assessment) score and the duration of hospitalization (days) in ICU. Methods: An observational, descriptive, prospective and longitudinal study with a quantitative nature was developed in an ICU ward in a hospital in Angola. Results: The sample was composed of 123 patients; the average value of the Braden scale was 14.15 points. Patients being treated with sedatives showed statistically significant difference in the average Braden scale score compared to those who did not. This difference was also verified in relation to the patients who were treated with vasopressors and mechanical ventilation. Negative, moderate to weak, but statistically significant correlations were found between the Braden scale score and the APACHE score, SOFA score and duration of ICU stay. De Alirio Martinho Belchior para Todos: 10:40 AM Conclusion: The patients have a higher risk of developing pressure ulcers when exposed to risk factors that are already known and specifically associated with some treatments implemented in the ICU. Higher rates of disease severity, mortality risk and longer duration of stay in ICU are associated with a higher risk of PU.

“…The results revealed that non-sedated patients had a higher prevalence of MDR IPs when compared to those who were sedated. 16 On the other hand, sedation can lead to a longer ICU stay, compromising physical mobility, increasing the time of mechanical ventilation, and contributing to the need for prolonged use of medical devices. 5 Although the professionals perceive that MDR PIs are recurrent in the ICU (DSC1), they recognize their (de)valuation in the context of critical care, as shown by DSC3.…”

Section: Dsc5mentioning

confidence: 99%

Percepção de profissionais de enfermagem sobre lesões por pressão relacionadas a dispositivos médicos

et al. 2021

Resumo Objetivo Conhecer a percepção de profissionais de enfermagem atuantes em unidade de terapia intensiva acerca das lesões por pressão relacionadas a dispositivos médicos. Método Pesquisa qualitativa, descritiva, realizada com 12 profissionais de enfermagem de um hospital público de ensino de Santa Catarina. A coleta de dados se deu por entrevista semiestruturada, e análise pela técnica do discurso do sujeito coletivo com o emprego do software QualiQuantiSoft®. Resultados Emergiram cinco Ideias Centrais: tipos de dispositivos e ocorrência das lesões por pressão relacionadas a dispositivos médicos; (in)visibilidade e (des)valorização destas lesões no cuidado ao paciente crítico; lesões por pressão relacionadas a dispositivos médicos podem ser inevitáveis; perfil do paciente crítico e risco para desenvolver a lesão; e (des)conhecimento profissional sobre o impacto da lesão na vida das pessoas após alta da terapia intensiva. Conclusão e implicações para a prática A percepção da enfermagem acerca das lesões por pressão relacionadas a dispositivos médicos está vinculada aos tipos de dispositivos, a ocorrência das lesões na terapia intensiva, ao cuidado ofertado e ao impacto das lesões na vida das pessoas.