Pressure Ulcer Formation Research Articles

The use of a combined profunda femoris perforator-based fasciocutaneous flap and gracilis muscle flap in the treatment of ischial pressure wounds in patients with limited mobility

BackgroundAlthough general principles of pressure wound management begin with optimisation of patient and wound factors to promote healing, refractory cases may require surgical intervention. Compared with other areas, ischial tuberosity (IT) wounds tend to occur in wheelchair-bound patients and may respond well to surgical debridement and flap reconstruction where added tissue bulk is preventative for further pressure ulcer formation. IT ulcers may occur in patients with some degree of ambulatory potential or those who have a temporary impairment. While the most commonly used flap for typical IT ulcers is the musculocutaneous hamstring flap, for these patients, this is not suitable due to the sacrifice of muscle function. We designed a combined posterior thigh flap with pedicled gracilis to provide robust coverage and vascularised muscle bulk, while preserving hamstring function and potential for re-advancement in ulcer recurrence.MethodsPatients were selected for their grade of ulcer, compliance with physiotherapy, and their need to preserve muscle function. Each underwent surgical debridement and reconstruction using the combination flap. End-points included wound coverage, post-operative mobility, and complications. Follow-up was 3 months post-surgery.ResultsAll patients achieved complete coverage of their wound. In the follow-up period, there were no wound complications or ulcer recurrence.ConclusionWe describe a novel reconstruction method for IT pressure ulcers that maintains patient mobility. This combination perforator-based fasciocutaneous and gracilis flap is a superior reconstructive option that has reduced donor site morbidity and relatively simple operative technique and can be reutilised in ulcer recurrence.Level of Evidence: Level V, therapeutic study.

Yatağa Bağımlı Hastalarda Pozisyon Süresinin Basınç Yarası Oluşumu Üzerine Etkisi

Yatağa Bağımlı Hastalarda Pozisyon Süresinin Basınç Yarası Oluşumu Üzerine Etkisi

The characterization of a pressure sensor constructed from a knitted spacer structure

Background and Objectives: This study investigates a novel type of textile pressure sensor fabricated in a single production step. The work characterizes two designs of electronic textile pressure sensor creating new knowledge into the operation of these types of textile sensors. Interest in electronic flexible film and electronic textile pressure sensing has grown in recent years given their potential in medical applications, principally in developing monitoring solutions for wheelchair users and hospital patients to help prevent the formation of pressure ulcers. Materials and Methods: Two designs of textile pressure sensor were produced using computerized flat-bed knitting. One design was produced in a single step, where the conductive tracks were incorporated into the top and bottom surfaces of a knitted spacer structure (knitted spacer pressure sensor). The other sensor was comprised of separate knitted layers. The response of the sensors was tested by changing the applied pressure in two ways: By altering the applied force or changing the area of the applied force. Sensor hysteresis and how the sensor thickness affected its response were also examined. Results: The two sensor designs behaved differently under the tested conditions. The knitted spacer pressure sensor was pressure sensitive up to 25 kPa and showed no hysteretic effects over the pressure range of interest. Conclusions: This study presents a fully textile pressure sensor that was produced with a single production step and demonstrates its functionality over the pressure range of interest for monitoring wheelchair users.

A case of acute skin failure misdiagnosed as a pressure ulcer, leading to a legal dispute.

It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.

Outcomes in socioeconomically disadvantaged patients with spinal cord injury: a systematic review.

OBJECTIVEIndividuals with a spinal cord injury (SCI) in socioeconomically disadvantaged settings (e.g., rural or low income) have different outcomes than their counterparts; however, a contemporary literature review identifying and measuring these outcomes has not been published. Here, the authors' aim was to perform a systematic review and identify these parameters in the hope of providing tangible targets for future clinical research efforts.METHODSA systematic review was performed to find English-language articles published from 2007 to 2017 in the PubMed/MEDLINE, EMBASE, and SCOPUS databases. Studies evaluating any outcomes related to patients with an SCI and in a low-resource setting were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a flowchart was created. Of the 403 articles found, 31 underwent complete review and 26 were eligible for study inclusion. According to the current study criteria, any case studies, studies in less developed countries, studies including and not separating other types of neurological disorders, studies not assessing the effects of a low-resource setting on outcomes in patients with SCI, and studies evaluating the causes of SCI in a low-resource setting were excluded.RESULTSIn SCI patients, a lower income was a predictor of death (OR 2.1, 95% CI 1.7-2.6, p = 0.0002). Moreover, secondary outcomes such as pain intensities (OR 3.32, 95% CI 2.21-4.49, p < 0.001), emergency room visits (11% more likely, p = 0.006), and pressure ulcer formation (OR 2.1, 95% CI 1.5-3.0, p < 0.001) were significantly higher in the lower income brackets. Rurality was also a factor and was significantly associated with increased emergency room visits (OR 1.5, 95% CI 1.1-2.1, p = 0.01) and lower outpatient service utilization (incidence rate ratio [IRR] 0.57, 95% CI 0.35-0.93, p < 0.05).CONCLUSIONSThe authors showed that individuals in a low-resource setting who have suffered an SCI have significantly different outcomes than their counterparts. These specific outcomes are promising targets for future research efforts that focus on improving health conditions among this population.

Free flap and kickstand external fixator in foot and ankle soft tissue reconstruction. The versatility of a microsurgical-friendly application of an orthopedic device

IntroductionFoot and ankle are prone to injuries and often require free flap for complex soft tissue reconstruction due to the insufficiency of local soft tissue. Lower limb reconstruction can be commonly compromised by venous insufficiency, and the elevation of the limb represents a critical component of the postoperative care. This study aims to explore the versatility of combining free soft tissue flap reconstruction for complex foot and ankle defect with a temporary Kickstands External Fixator (KEF) placement. Materials and methodsA retrospective analysis was performed on 14 patients with unilateral foot or ankle complex soft tissue defects (post-traumatic, soft tissue infection and osteomyelitis, chronic skin ulcer, sarcoma), treated with free flap and KEF placement. Patients’ demographics, etiology of injury, type of reconstruction, duration of KEF, complications related to the flap and the KEF placement were recorded. ResultsThe mean age of patients was 52.57-year-old (range 35–68). The average follow up was 15.5 months (range: 3–25). An anterolateral thigh (ALT) flap was performed in 12 patients; 2 patients received composite forearm free flap plus flexor carpalis radial for Achilles tendon reconstruction. The average time for KEF removal was 378 weeks. All flaps survived, though partial necrosis was observed in 1 case. No complication at the flap donor site or related to the KEF placement was observed. No equinus deformity was reported. ConclusionThe KEF placement when performing a complex soft tissue free flap reconstruction of foot and ankle could be an effective method to guarantee limb elevation, avoid pressure on the flap especially in posterior reconstructions, avoid heel pressure ulcer formation and equinus deformity.

Favorable Outcome of Severe Acute Methadone Poisoning (Clinical Case)

Purpose: to contribute to relief of metabolic disorders associated with hypoxia by including a succinate correcting tissue metabolism into the scheme of intensive care of acute severe methadone poisoning complicated by the crush syndrome. Materials and methods. We examined the dynamics of clinical manifestation of acute methadone poisoning complicated by crush syndrome: changes in clinical and biochemical parameters, coagulation test findings, blood gas composition and acid-base state, ECG and X-ray findings. Results. By the 7th day after patient's admission in the ICU, stabilization of hemodynamics, recovery of spontaneous breathing and consciousness, reduction of swelling and the beginning of the formation of pressure ulcers were observed; on the 8 the day, restoration of urination and characteristics of urine were registered. On the 12th day, the patient was transferred to the toxicology unit being in a state of moderate severity and demonstrating positive changes in all clinical parameters. Conclusion. The inclusion of a drug with antioxidant/antihypoxant properties in the infusion therapy scheme allows to relieve metabolic disorders associated with hypoxia, and thereby increase the effectiveness of treatment: i.e. to relief clinical and laboratory manifestations and reduce the ICU stay.

LB1612 Botulinum toxin B suppresses the pressure ulcer formation in cutaneous ischemia-reperfusion injury mouse model: Possible regulation of oxidative and endoplasmic reticulum stress

There is increasing evidence that cutaneous ischemia-reperfusion (I/R) injury is associated with the development of pressure ulcers (PUs). Botulinum toxin (BTX) suppress the release of neurotransmitters such as acetylcholine in the neuromuscular junction. Several studies have demonstrated that BTX enhanced the blood flow and survival of ischemic skin flaps in animal cutaneous flap models. The objective of this study is to assess the effects of BTX-B on the formation of PUs in the cutaneous I/R injury. In the cutaneous I/R injury mouse model, I/R injury-induced vascular damage, hypoxic area, and the number of oxidative stress-associated DNA-damaged cells and apoptotic cells were suppressed by BTX-B injection. BTX-B significantly inhibited cutaneous I/R injury-induced oxidative stress in OKD48 mice by bioluminescence. BTX-B reduced the I/R-induced mRNA levels of oxidative stress-associated factors, including HO-1, Nox2, and Nrf2. In an in vitro assay, BTX-B significantly inhibited the oxidant-induced ROS and apoptotic endothelial cells and fibroblasts. In addition, BTX-B significantly inhibited cutaneous I/R injury-induced endoplasmic reticulum (ER) stress in ERAI mice by bioluminescence. Cutaneous I/R injury-induced ER stress-response factors and GRP78/BiP- and CHOP-positive cells in the I/R area were significantly decreased by BTX-B injection. These results suggest that BTX-B injection might have protective effects against PU formation after cutaneous I/R injury by reducing vascular damage, inhibiting hypoxia-induced oxidative cellular damage, decreasing oxidative and ER stress, and preventing apoptosis.

Clinical effects of enteral nutrition with eicosapentaenoic acids in the prevention of new pressure ulcer formation in critically Ill patients with cerebrovascular disease. A randomized, prospective, controlled study

Clinical effects of enteral nutrition with eicosapentaenoic acids in the prevention of new pressure ulcer formation in critically Ill patients with cerebrovascular disease. A randomized, prospective, controlled study

The impact of nutritional status on the process of formation of pressure ulcers in a patient in intensive care after injury cerebro-cranial

The impact of nutritional status on the process of formation of pressure ulcers in a patient in intensive care after injury cerebro-cranial

Early detection and monitoring of chronic wounds using low-cost, omniphobic paper-based smart bandages

The growing socio-economic burden of chronic skin wounds requires the development of new automated and non-invasive analytical systems capable of wirelessly monitoring wound status. This work describes the low-cost fabrication of single-use, omniphobic paper-based smart bandages (OPSBs) designed to monitor the status of open chronic wounds and to detect the formation of pressure ulcers. OPSBs are lightweight, flexible, breathable, easy to apply, and disposable by burning. A reusable wearable potentiostat was fabricated to interface with the OPSB simply by attaching it to the back of the bandage. The wearable potentiostat and the OPSB can be used to simultaneously quantify pH and uric acid levels at the wound site, and wirelessly report wound status to the user or medical personnel. Additionally, the wearable potentiostat and the OPSBs can be used to detect, in an in-vivo mouse model, the formation of pressure ulcers even before the pressure-induced tissue damage becomes visible, using impedance spectroscopy. Our results demonstrate the feasibility of using inexpensive single-use OPSBs and a reusable, wearable potentiostat that can be easily sterilized and attached to a new OPSB during the dressing change, to provide long term wound progression data to guide treatment decisions.

Hydrogen gas inhalation protects against cutaneous ischaemia/reperfusion injury in a mouse model of pressure ulcer.

Pressure ulcer formation depends on various factors among which repetitive ischaemia/reperfusion(I/R) injury plays a vital role. Molecular hydrogen (H2) was reported to have protective effects on I/R injuries of various internal organs. In this study, we investigated the effects of H2 inhalation on pressure ulcer and the underlying mechanisms. H2 inhalation significantly reduced wound area, 8‐oxo‐dG level (oxidative DNA damage) and cell apoptosis rates in skin lesions. H2 remarkably decreased ROS accumulation and enhanced antioxidant enzymes activities by up‐regulating expression of Nrf2 and its downstream components in wound tissue and/or H2O2‐treated endothelia. Meanwhile, H2 inhibited the overexpression of MCP‐1, E‐selectin, P‐selectin and ICAM‐1 in oxidant‐induced endothelia and reduced inflammatory cells infiltration and proinflammatory cytokines (TNF‐α, IL‐1, IL‐6 and IL‐8) production in the wound. Furthermore, H2 promoted the expression of pro‐healing factors (IL‐22, TGF‐β, VEGF and IGF1) and inhibited the production of MMP9 in wound tissue in parallel with acceleration of cutaneous collagen synthesis. Taken together, these data indicated that H2 inhalation suppressed the formation of pressure ulcer in a mouse model. Molecular hydrogen has potentials as a novel and alternative therapy for severe pressure ulcer. The therapeutic effects of molecular hydrogen might be related to its antioxidant, anti‐inflammatory, pro‐healing actions.

Development of Personalized Fitting Device With 3-Dimensional Solution for Prevention of NIV Oronasal Mask-Related Pressure Ulcers.

Pressure ulcers related to oronasal masks used with noninvasive ventilation (NIV), along with patient discomfort, occur due to improper fit of the mask. We developed a personalized fitting device using a 3-dimensional (3D) scanning solution to prevent the formation of NIV mask-related pressure ulcers. This study aimed to evaluate the effectiveness of the proposed personalized fitting device. We conducted a randomized crossover experimental study of 20 healthy participants to study the use of this personalized fitting device between the face and an NIV mask designed with 3D solutions. The fitting device was not used under the NIV mask for the control. The outcome measures were the presence of blanchable erythema, standardized redness intensity, discomfort level, and contact pressure. The incidence of blanchable erythema and standardized redness intensity values were significantly lower for subjects who used the fitting device when worn for 30 min (P < .001). The discomfort levels at the forehead, nasal bridge, and both cheeks, as well as leakage, were significantly reduced as well (P = .008, P < .001, P = .001, P = .002, P = .001, P = .02, P < .001, P < .001, P < .001). Contact pressure at the nasal bridge, where pressure ulcers most frequently develop, was significantly decreased with the fitting device (P < .001). Personalized fitting devices that incorporate 3D scanning solutions may contribute to the prevention of NIV mask-related pressure ulcers and the reduction of discomfort.

Botulinum toxin B suppresses the pressure ulcer formation in cutaneous ischemia-reperfusion injury mouse model: Possible regulation of oxidative and endoplasmic reticulum stress

BackgroundWe previously identified that botulinum toxin A (BTX-A) suppressed pressure ulcer (PU) formation after cutaneous ischemia-reperfusion (I/R) injury; however, regulation of cutaneous I/R-induced oxidative and endoplasmic reticulum (ER) stress by BTX-B was not investigated. Additionally, the efficacy of BTX-B injection has never been examined. ObjectiveObjective was to assess the effects of BTX-B on the formation of PU by cutaneous I/R injury, and the regulation of oxidative and ER stress in I/R injury by BTX-B. MethodsBTX-B was subcutaneously injected into I/R area, and wound size, vascular damage, hypoxic area, and apoptotic cells in I/R area were analyzed. We evaluated the extent of oxidative and ER stress in I/R area by using OKD48 mice and ERAI mice, respectively, which enabled evaluating oxidative and ER stress through bioluminescence detection. ResultsBTX-B injection significantly suppressed the formation of PU by cutaneous I/R injury. Cutaneous I/R-induced vascular damage, hypoxic area, and number of oxidative-damaged cells and apoptotic cells were suppressed by BTX-B injection. BTX-B administration significantly inhibited I/R-induced oxidative stress signal in OKD48 mice. BTX-B reduced the I/R-induced oxidative stress-associated factors. BTX-B significantly inhibited the oxidant-induced reactive oxygen species and apoptosis of endothelial cells and fibroblasts. BTX-B significantly inhibited I/R-induced ER stress signal in ERAI mice. Cutaneous I/R injury-induced ER stress-response factors and GRP78/BiP and CHOP-positive cells in I/R area were significantly decreased by BTX-B injection. ConclusionBTX-B injection might have protective effects against PU formation after cutaneous I/R injury by reducing vascular damage, hypoxia-induced oxidative and ER stress, and apoptosis.

Pure Omental Lipid (P.O.L.) for the Treatment of Fragile Skin: A Pharmacological and Clinical Review

The omentum is a large peritoneal fold. It begins at the stomach and extends down-wards to cover the abdominal organs. It serves a primarily protective role, especially in defending against infective agents and to promote tissue reparation after injuries. The omentum is characterized by extensive vascularization, sign of a metabolically active environment. Furthermore, omentum is the tissue with the highest production of vascular endothelial growth factor (VEGF) in the body. The lipids contained in this tissue carry out very important activities for the organism, and the presence of neutral glycerides, phospholipids, glycolipids, and gangliosides suggests the potential usefulness of heterologous omental lipid fractions in dermatology. Omentum stimulates vascular proliferation, therefore is possible to speculate its topical use in therapies designed to regenerate skin tissue in clinical conditions characterized by fragile skin. Dermatological products containing purified omental lipids are commercially available. Pure porcine omental lipids (P.O.L.) could be use in topical products in different textures (cream, fluid, emulsions, and cleanser) and at different concentrations (10-25%) for the treatment of fragile skin or other skin conditions at risk of ulcer formation (the so-called dermatoporosis of the elderly, severe skin xerosis in diabetic subjects, skin at risk of pressure ulcers). This review summarizes the pharmacological rationale of purified porcine omental lipids in topical formulations for the use in fragile skin conditions and the clinical efficacy data available in the scientific literature. Several clinical controlled trials conducted in 320 subjects have shown that topical porcine purified omental lipids are able to prevent the formation of pressure ulcers in hospitalized high-risk subjects, to improve wound healing process, to normalize skin hydration in diabetic subjects with moderate-severe skin xerosis and to improve clinical evolution of diabetic foot. Therefore, purified omental lipid could be an effective tool for the management of fragile skin and the skin at high risk of ulcer formation.

Protective effect of mesenchymal stem cells on the pressure ulcer formation by the regulation of oxidative and endoplasmic reticulum stress

Cutaneous ischemia-reperfusion (I/R) injury is associated with the early pathogenesis of cutaneous pressure ulcers (PUs). The objective of this study was to investigate the effect of mesenchymal stem cells (MSCs) injection on the formation of PUs after I/R injury and determine the underlying mechanisms. We found that the subcutaneous injection of MSCs into areas of I/R injured skin significantly suppressed the formation of PUs. I/R-induced vascular damage, hypoxia, oxidative DNA damage, and apoptosis were decreased by MSCs injection. Oxidative stress signals detected after I/R in OKD48 (Keap1-dependent oxidative stress detector, No-48-luciferase) mice were decreased by the injection of MSCs. In cultured fibroblasts, MSCs-conditioned medium significantly inhibited oxidant-induced reactive oxygen species (ROS) generation and apoptosis. Furthermore, endoplasmic reticulum (ER) stress signals detected after I/R in ERAI (ER stress-activated indicator) mice were also decreased by the injection of MSCs. These results suggest that the injection of MSCs might protect against the development of PUs after cutaneous I/R injury by reducing vascular damage, oxidative cellular damage, oxidative stress, ER stress, and apoptosis.

Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study.

Secondary analysis of data from a prospective cohort study. The objective of this study was to identify the medical and demographic factors associated with the development of pressure ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. Adults with acute traumatic spinal cord injury (n=104) were recruited within 24-72 h of admission to the hospital. Pressure ulcer incidence was recorded. Thirty-nine participants out of 104 (37.5%) developed at least one pressure ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure ulcer incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1-20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3-16.63), P=0.01. Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure ulcers. Pneumonia was noted to be associated with the formation of pressure ulcers.

Validity of the Braden Scale in grading pressure ulcers in trauma and burn patients

BackgroundPressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of ≤18 is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and nontrauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients. MethodsWe collected data from medical records regarding documented Braden scores and presence of pressure ulcers regardless of staging. Patients with ulcers present on admission were excluded from analysis. For each patient, the lowest Braden score documented before the occurrence of the pressure ulcer was determined. A logistic regression was used to estimate odds ratios and associated 95% confidence intervals for the association between pressure ulcer likelihood and lowest Braden Scale measurement. To determine the discriminatory ability of the Braden Scale on pressure ulcer risk, four measures of performance (i.e., sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) were calculated for four nonmutually exclusive groups: a Braden Scale measurement ≤18, ≤14, ≤12, and ≤9. ResultsFrom 2011 through 2014, a total of 2660 patients were admitted to the trauma/burn intensive care unit. Of these patients, 63 (2.3%) subsequently developed a pressure ulcer. A Braden Scale of ≤18 as the threshold for being at-risk of pressure ulcer had a sensitivity of 100% and specificity of 6%, whereas a Braden Scale of ≤9 had a sensitivity of 28.6% and a specificity of 90%. For all Braden Scale measurements, the positive likelihood ratio never reached the value of 10 that suggests high likelihood of an ulcer. ConclusionsThe Braden scale has mediocre discriminatory ability among the trauma/burn population. In addition, the low positive likelihood ratio suggests that the Braden scale may not be a useful clinical tool as it may result in unnecessary expenditure of time and personnel resources in preventing pressure ulcer formation.

Development of a model to demonstrate the effects of friction and pressure on skin in relation to pressure ulcer formation

Pressure ulcers are a common injury of the skin which leads to pain and potential infection for patients and financial burden to the healthcare providers across the global due to treatment costs, litigation and extended hospital stays. The current study focuses on one of the causes of pressure ulcer formation, ischemia. Blood vessels are deemed to be deformed and blood flow restricted when skin is subjected to external mechanical loads including friction, pressure and the combination of both. Hence, normal oxygen delivery to cells or metabolic waste removal are locally stopped which causes cells deaths and ultimately pressure ulcers.The current study proposes a 3D finite element analysis model which is capable of demonstrating the effect of friction, pressure and the combination of both to the deformation of blood vessels. The results of simulation suggested that applied pressure collapsed the blood vessels while friction opened up the blood vessels. However, as a combination effect of pressure and friction, the cross-sectional areas of blood vessels were reduced significantly. This model is clinically and physiologically relevant in terms of loading regime and blood vessels structures. The model with further development can be adopted to be an effective tool to evaluate the effects of medical devices to the possibility of pressure ulcer formation.

Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study

ObjectiveTo identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs). DesignRetrospective. SettingAcute hospitalization and inpatient rehabilitation unit of a university medical center. ParticipantsIndividuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. InterventionsNot applicable. Main Outcome MeasuresTwenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. ResultsInitial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (P<.05) between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and a decrease in urine concentrations of TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia. ConclusionsThese findings suggest that a relatively small increase in plasma TNF-α, and decreases in urine TNF-α, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI.