The incidence of pressure ulcer in patients on mechanical ventilation andeffects of selected risk factors on pressure ulcer development*

Abstract

IntroductionA pressure ulcer (PU) is localized tissue damage in the dermis and subdermis caused by compression, friction, shearing, and other factors (1). It is commonly encountered in all hospitalized patients, especially those in intensive care units (ICUs) (2). The incidence of PU was found to increase from 4% to 49% in Denmark and vary from 38% to 24% in Germany (3) and from 14% to 42% in the United States (4,5). Studies from Turkey showed that the incidence of PU varied between 15% and 29% (6-8).Mobilization, sensorial perceptions, and consciousness in patients in ICUs are impaired due to the administration of sedative and anesthetic agents (9-11). It has been shown that vasopressin administered to maintain sufficient cardiac output in ICUs leads to constriction in the capillary circulation, which prevents oxygen and blood supply to the skin. This creates a risk of PU (12). Changes in metabolism resulting from such conditions as major surgery, burns, major trauma, and sepsis in ICUs increase the risk of PU development (9-13). In addition, the risk of PU is increased due to impairment of hemodynamic status, cardiovascular diseases, circulatory failure, impaired oxygenation, diabetes mellitus, anemia, infection, edema, catabolic disorders, and pressure (4,10,11,14). In a systematic review, it was reported that PU is not caused by a single factor, but rather develops due Background/aim: This study aimed to determine the incidence of pressure ulcers in patients on mechanical ventilation and selected risk factors likely to play a role in pressure ulcer development. Materials and methods:The study included 110 patients recruited from an anesthesia critical care unit of a university hospital. Data were collected with a demographic and clinical characteristics form. The form was composed of questions about demographic characteristics and clinical features including diagnosis, duration of mechanical ventilation, general well-being, oxygenation, perfusion, and skin condition. Results:The incidence of pressure ulcer was 15.5%. Duration of mechanical ventilation was longer and the body mass index was higher in patients developing pressure ulcers than in those without pressure ulcers. Additionally, 90.11% of patients with pressure ulcers had edema and 82.35% of patients with pressure ulcers received vasopressin. The patients with pressure ulcers had higher PH levels, lower PaO2 levels, higher PCO2 levels, lower SaO2 levels, and higher urine output. Conclusion:It can be recommended that nurses and other health professionals should be aware of factors playing a role in pressure ulcer development and should be able to conduct appropriate interventions to prevent pressure ulcers.

Incidence of Pressure Ulcers In The Patients On Mechanical Ventilation: A Prospective Study

“…[4,8] In the previous studies, it was shown that pressure ulcers developed significantly at second week of mechanical ventilation treatment and mechanical ventilation treatment lasting longer than 20 days might be associated with pressure ulcers. [3,9] At the end of this current study, the incidence of stage I pressure ulcer was found to be 10.8% at 10 hours after the initiation of mechanical ventilation treatment and the incidences were found to be 58.5% at first week and 71.15% at second week as parallel to the data in the literature. This situation confirmed that pressure ulcer development rates increased with the extension of the duration of mechanical ventilation treatment.…”

“…Mechanical ventilation treatment has been reported to be a factor causing pressure ulcers due to its impairing effect on blood circulation at epidermal and subcutaneous tissue and on the balance between ventilation-perfusion by affecting pumping function of the heart. [9,11] In a study which was conducted in six centers, it was indicated that patients who were on mechanical ventilation treatment were at a higher risk compared to the others receiving inpatient treatment. [3] In a study which was carried out in surgical intensive care units, development of pressure ulcers was significantly enhanced by the increase in the days of ventilation, dialysis and gaita incontinence; and besides, the number of days for using norepinephrine and lactic acid level in arterial blood were determined to create a high risk for pressure ulcers.…”

“…[3][4][5][6][7] In Turkey, the incidence of pressure ulcers was reported to be 17% in intensive care units and 15.5% among the patients who underwent a mechanical ventilation treatment at least for 24 hours. [8,9] More than a hundred factors causing pressure ulcers were identified in the literature. [1][2][3][4][5][6][7][8][9] Intensive care patients constitute a patient group having multiple risks especially for pressure ulcers.…”

“…[8,9] More than a hundred factors causing pressure ulcers were identified in the literature. [1][2][3][4][5][6][7][8][9] Intensive care patients constitute a patient group having multiple risks especially for pressure ulcers. Pressure ulcer makes patient to feel pain, delays the treatment of primary disease and decreases the quality of life following discharge.…”

Incidence, Prevention and Treatment of Pressure Ulcers in Intensive Care Patients

“…Günümüzde (17). Ağrı, hipotansiyon, hipertermi, azalmış bilinç seviyesi, hipoalbüminemi, düşük hemoglobin seviyeleri, malnütrisyon, obezite, dehidrasyon, sigara içmek, ileri yaş, diyabet, aşırı nem, hastanede kalış süresinin uzaması, uzamış mekanik ventilasyon süresi bilinen diğer risk faktörleridir (13,18). Çalışmamızda sakrum ve koksiks en sık bası yarası gelişen bölgelerdi (pelvik alan %88, torakonter %12) ve mekanik ventilasyon gün ortalaması çok uzundu (50,21/gün).…”