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To prospectively investigate the risk factors that associate to ala nasi pressure sores after general anesthesia with nasotracheal intubation. Material and method: All Patients underwent oral and maxillofacial surgeries during May 2018 to December 2018 were enrolled in this prospective study. Alae nasi were evaluated after finishing of the operation under general anesthesia with nasotracheal intubation for having pressure sore or not. The seven suspected risk factors were investigated for evaluation of the significant association with ala nasi pressure sores. Descriptive, univariate, and multivariate statistics were computed, and the P value was set at .05. Results: One hundred and fifty-five patients were enrolled. The incident of ala nasi pressure sore after general anesthesia with nasotracheal intubation was 21.45% in duration of six months. Risk factors associated with ala nasi pressure sore with univariate analysis were long duration of surgery, and lack of hydrocolloid dressing. After multivariate analysis, the significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation were long duration of surgery (OR 1.005, 95%CI 1.002 to 1.009, p ¼ 0.004), and lack of hydrocolloid dressing (OR 9.934, 95%CI 3.347 to 29.489, p < 0.001). While the significant protective factor was higher body mass index (OR 0.864, 95% CI 0.749 to 0.997, p ¼ 0.045). Conclusion: Long duration of surgery and lack of hydrocolloid dressing are significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation. While high body mass index is significant protective factor. Shortening the duration of surgery and using of hydrocolloid dressing between ala nasi and the nasotracheal tube or catheters that inserted via nose, such as nasogastric tube, are strongly recommended.
To prospectively investigate the risk factors that associate to ala nasi pressure sores after general anesthesia with nasotracheal intubation. Material and method: All Patients underwent oral and maxillofacial surgeries during May 2018 to December 2018 were enrolled in this prospective study. Alae nasi were evaluated after finishing of the operation under general anesthesia with nasotracheal intubation for having pressure sore or not. The seven suspected risk factors were investigated for evaluation of the significant association with ala nasi pressure sores. Descriptive, univariate, and multivariate statistics were computed, and the P value was set at .05. Results: One hundred and fifty-five patients were enrolled. The incident of ala nasi pressure sore after general anesthesia with nasotracheal intubation was 21.45% in duration of six months. Risk factors associated with ala nasi pressure sore with univariate analysis were long duration of surgery, and lack of hydrocolloid dressing. After multivariate analysis, the significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation were long duration of surgery (OR 1.005, 95%CI 1.002 to 1.009, p ¼ 0.004), and lack of hydrocolloid dressing (OR 9.934, 95%CI 3.347 to 29.489, p < 0.001). While the significant protective factor was higher body mass index (OR 0.864, 95% CI 0.749 to 0.997, p ¼ 0.045). Conclusion: Long duration of surgery and lack of hydrocolloid dressing are significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation. While high body mass index is significant protective factor. Shortening the duration of surgery and using of hydrocolloid dressing between ala nasi and the nasotracheal tube or catheters that inserted via nose, such as nasogastric tube, are strongly recommended.
Objectives: To investigate the efficacy of hydrocolloid dressing in reducing the occurrence rate and severity of nasotracheal tube-related pressure injury. Design: Randomized controlled trial. Setting: A PICU in a tertiary medical center in southern China. Patients: Pediatric patients received invasive mechanical ventilation via nasotracheal tubes. Interventions: The hydrocolloid dressing was cut into an optimal square size, which should cover the area from the nasal columella to the ala. Measurements and Main Results: Eligible participants were randomly allocated to the control group and the experimental group. The participants in the experimental group received hydrocolloid dressing to protect nasal skin from the beginning of nasotracheal intubation, while the participants in the control group received the current care procedure (without hydrocolloid dressing) unless pressure injuries occurred. The hydrocolloid dressing was changed daily to assess the nasal skin. The pressure injury staging system that was redefined and updated by the National Pressure Ulcer Advisory Panel in 2016 was used. The mean duration of nasotracheal intubation was 150.10 ± 117.09 hours in the experimental group and 161.75 ± 120.72 hours in the control group. Forty-five participants had nasotracheal tube-related pressure injuries in control group, whereas 26 patients had in experimental group (72.6% vs 43.3%; absolute difference, 29.3%, 95% CI, 12.5–46%; p = 0.001). The median survival times of the nasal skin integrity were 95.5 hours in the control group and 219.5 hours in the experimental group (p < 0.001). Conclusions: Hydrocolloid dressing can not only reduce the occurrence rate of nasotracheal tube-related pressure injury in the child with long-term nasotracheal intubation but also improve the endurance of the nasal skin significantly.
PURPOSE: To compare a hydroactive dressing to an adhesive tape standard of care in the prevention of nasal ala pressure injuries associated with nasotracheal intubation during orthognathic surgery. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The study took place in a tertiary hospital of stomatology in China. Patients undergoing general anesthesia with nasotracheal intubation during orthognathic surgical procedures were invited to participate. METHODS: Participants were divided into 2 groups: in the experimental group, a hydroactive dressing was applied to the nasal ala before the surgical procedures; the control group received standard prevention with a type of tape. Skin assessments were performed on the wards up to 72 hours after the procedures. Demographic information and potential contributing factors associated the development of nasal ala pressure injuries were collected from patients' electronic medical records. Pressure injury development was staged using National Pressure Injury Advisory staging guidelines. Pressure injury incidence was compared between groups using the χ2 test and odds ratio. RESULTS: The sample comprised 450 participants, 225 in each group. The incidence of nasal ala pressure injuries development was 14.222% and 4.444% in the 2 groups, respectively (P = .000). The odds ratio was 3.565 (95% confidence interval, 1.707-7.443). CONCLUSIONS: The study findings indicate that the incidence of pressure injuries of nasal ala skin protected by hydroactive dressings was lower than the standard preventive method. Hydroactive dressings should be considered as a prevention method to reduce device-related skin injuries associated with nasotracheal intubation.
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