Prevention of pressure injuries during military aeromedical evacuation or prolonged field care: A randomized trial

Bridges, Elizabeth; Whitney, JoAnne D.; Metter, Debra; Burr, Robert L.

doi:10.1016/j.outlook.2022.08.009

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Higher body temperature is associated with inflammation, while hypothermia can be attributed to malperfusion 22 . The effect on reactive congestion (an indicator of ischemia) for every 1°C increase in skin temperature equals an 8–15 mmHg rise in skin interface pressure 23 . Besides, keeping the supine position for 1 h can lead to a 3°C increase in skin temperature 24 .…”

Section: Discussionmentioning

confidence: 99%

“…22 The effect on reactive congestion (an indicator of ischemia) for every 1 C increase in skin temperature equals an 8-15 mmHg rise in skin interface pressure. 23 Besides, keeping the supine position for 1 h can lead to a 3 C increase in skin temperature. 24 In this investigation, no patient presented with a ΔT value of over 3 C, and the highest ΔT value was 0.5 C. This might be caused by factors such as subjects, environmental temperature, and the anaesthesia status.…”

Section: Skin Temperature and Iapismentioning

confidence: 99%

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Effect of “micromovement” in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position

Jin,

Liu,

Shentu

et al. 2023

International Wound Journal

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To explore the clinical effect of “micromovement” in preventing intraoperative acquired pressure injures (IAPIs) among patients experiencing surgery in supine position. A total of 200 patients accepting elective surgery in supine position from 10 May 2023 to 4 July 2023 at Shulan (Hangzhou) Hospital were selected and randomized into two groups (experimental group, n = 100; control group, n = 100). For control group patients, soft silicone foam dressing was applied to the sacrococcygeal region. On the basis of the treatment for control group patients, “micromovement” was implemented among experimental group patients. During this process, the operating table was tilted for 15° leftwards and rightwards alternately every 1 h, and the tilt angle was maintained for 5 min to prevent IAPIs. Finally, comparisons between the two groups were made in terms of the sacrococcygeal IAPI incidence, relative temperature differences (ΔT) on sacrococcygeal skin, and job satisfaction of nurses. Compared with control group patients, patients from the experimental group exhibited lower IAPI incidence (2% vs. 10%), reduced ΔT between the sacrococcygeal skin and surrounding normal skin [0 (−0.1, 0.1) vs. 0.2 (−0.2, 0.4)], and elevated job satisfaction of nurses (80% vs. 66%). All the differences were statistically significant (p < 0.05). “Micromovement” implemented intraoperatively among patients receiving surgery in supine position is able to lower the IAPI incidence by five times and elevate job satisfaction of nurses.

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Section: Discussionmentioning

confidence: 99%

Section: Skin Temperature and Iapismentioning

confidence: 99%

Effect of “micromovement” in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position

Jin,

Liu,

Shentu

et al. 2023

International Wound Journal

View full text Add to dashboard Cite

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Pressure Injury Mitigation in Prolonged Care: A Randomized Noninferiority and Superiority Trial

et al. 2023

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Introduction Combat casualties are at increased risk for pressure injuries (PIs) during prolonged casualty care. There is limited research on operational PI risk mitigation strategies. The purpose of this study was to (1) compare a prototype mattress (AirSupport) designed for operational conditions versus the foldable Talon litter and Warrior Evacuation Litter Pad (WELP) on PI risk factors and (2) determine whether the Talon + AirSupport pad was noninferior and superior to the Talon + WELP on skin interface pressure. Materials and Methods Healthy adults (N = 85; 20 men and 65 women), aged 18 to 55 years, were stratified based on body fat percentage and randomized into three groups: Talon (n = 15), Talon + AirSupport (n = 35), and Talon + WELP (n = 35). The participants were asked to lie in a supine position for 1 hour. The outcomes included skin interface pressure (body surface areas: Sacrum, buttocks, occiput, and heels), sacral and buttock skin temperature and moisture, and discomfort and pressure. The study was approved by the University of Washington Institutional Review Board. Results Aim 1: The Talon had significantly higher peak skin interface pressure versus the AirSupport and WELP on the sacrum, buttocks, occiput, and heels. Skin temperature increase over the 1-hour loaded period was significantly lower on Talon versus AirSupport or WELP, reflecting a lower temperature–induced ischemic load. There was no significant difference in skin moisture changes or discomfort between the surfaces. Aim 2: The upper confidence limits for the difference in skin interface pressure (all body surface areas) for AirSupport versus WELP were below 25 mm Hg, establishing noninferiority of the AirSupport to the WELP. AirSupport was also superior to WELP for the peak interface pressure on the sacrum, occiput, and heels but not on the buttocks. Skin temperature changes (sacrum or buttocks) were not significantly different between the AirSupport and WELP. Conclusions The Talon litter presents a PI risk because of increased skin interface pressure, and hence, immediate action is warranted. The decreased PI risk associated with the lower skin interface pressures on the AirSupport and WELP was offset by the higher skin temperature, which may add the equivalent of 20 to 30 mm Hg pressure to the ischemic burden. Thus, any pressure redistribution intervention must be evaluated with a consideration for skin interface pressure, temperature, and moisture. Data from this study were applied to a predictive model for skin damage. Under operational conditions where resources and the environment may limit patient repositioning, it would be expected that casualties would suffer skin damage within 2 to 5 hours, with the occiput as the highest risk area. The severity of predicted skin damage is lowest on the AirSupport, which is consistent with the noninferiority and superiority of the AirSupport mattress compared to the WELP and Talon. Operational utility: The AirSupport and WELP, which were both superior to the Talon, are operationally feasible solutions to mitigate PI risk. The smaller size of the Talon (2.7 kgs compressible) versus the WELP (5 kgs noncompressible) may make them appropriate for different levels of the operational setting.

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Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project

Romito,

Talbot,

Metter

et al. 2023

Military Medicine

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Introduction The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. Methods We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. Results There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. Conclusion This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

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Prevention of pressure injuries during military aeromedical evacuation or prolonged field care: A randomized trial

Cited by 3 publications

References 27 publications

Effect of “micromovement” in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position

Effect of “micromovement” in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position

Pressure Injury Mitigation in Prolonged Care: A Randomized Noninferiority and Superiority Trial

Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project

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