Occurrence Of Pressure Ulcers Research Articles

Association between hypertension and pressure ulcer: A systematic review and meta-analysis.

This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science,and Cochrane Library were searched for studies from their inception until September 12, 2023. Literature search, data extraction, and quality assessment were conducted independently by two researchers. The random-effects model was used to calculate the combined odds ratio (OR) and corresponding 95% confidence interval (CI) of hypertension in patients with PU; subgroup analyses were performed to explore the source of between-study heterogeneity; sensitivity analysis was used to test the robust of the combined result; and funnel plot and Egger's test were used to assess the publication bias. Finally, a total of 19 studies with 564 716 subjects were included; the overall pooled result showed no significant association between hypertension and risk of developing PU (OR = 1.15, 95% CI = 0.90-1.47, p = 0.27); and the sensitivity analysis and publication bias analysis showed robust of the combined result. Subgroup analysis indicated a significant association between hypertension and PU when the primary disease was COVID-19 (OR = 1.73, 95% CI = 1.35-2.22, p < 0.0001). No association between hypertension and PU was seen in subgroup analysis on the patient source and study design. In sum, there is no significantly statistical association between hypertension and the occurrence of PU in most cases, while the risk of PU significantly elevates among COVID-19 patients combined with hypertension regardless of patient source and study design.

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis.

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

A nomogram to predict the risk of surgery-related pressure ulcers in patients undergoing cardiovascular surgery.

In this study, we aimed to establish a new nomogram score to predict the occurrence of surgery-related pressure ulcers (SRPU) in patients undergoing cardiovascular surgery. We conducted a retrospective study among patients who underwent cardiovascular surgery between February 2016 and November 2020. We established a prediction model based on a logistic regression model and tested the calibration and discrimination. We included 1163 patients who had undergone cardiovascular surgery. We formulated the logistic regression model, with Logit(P) = -11.745 + 0.024 preoperative hemoglobin value + 0.118 serum sodium value - 0.014 prealbumin value - 0.213 intraoperative mean temperature - 0.058 minimum mean arterial pressure + 0.646 preoperative blood potassium value + 0.264 smoking frequency + 0.760 hypertension history + 0.536 age ≥70 years. In this model ,"+" indicates that the factor is positively related to the occurrence risk of SRPU and "-" indicates that the factor is negatively associated with SRPU risk. The predictive model and nomogram had good accuracy in estimating the risk of SRPU, with a C-index of 0.755 (95% confidence interval: 0.719-0.792). The present model can be used to effectively screen patients with a high risk of SRPU to devise targeted nursing intervention strategies and ultimately reduce the incidence rate of SRPU.

Prediction Pressure Ulcers in High Care Unit Patients: Evaluating Risk Factors and Predictive Scale Using a Prospective Cross-Sectional Study.

Background The incidence of ulcer pressure in the high care unit (HCU) was relatively high and could be reliably predicted using tools such as the Norton and Jackson/Cubbin scales. However, other risk factors, such as age, gender, consciousness, systemic condition, duration of treatment, and use of restraint, may contribute to the occurrence of ulcer pressure. This study was conducted to analyze the relationship of various risk factors for pressure ulcers and prediction of ulcer pressure, using Norton and Jackson/Cubbin scale, to incident pressure ulcers in HCU patient. Methods This study utilized a prospective cross-sectional study design to analyze various risk factors for ulcer pressure development in a patient admitted to the HCU, including age, gender, blood profile, consciousness, duration of treatment, and use of restraint. The Norton and Jackson/Cubbin scale was employed to predict pressure ulcers. The relationship between the risk factors and the prediction of pressure ulcer incidents was evaluated using multiple logistic binary regression analysis. Result Both the Norton and Jackson/Cubbin scales predicted a lower risk of pressure ulcer development (60.98 and 99.02%, respectively). This prediction is consistent with the low incidence of pressure injuries found, which is only 4.39%. Furthermore, the relationship between the identified risk factor (gender, duration of treatment in HCU and use of restraint) and the prediction and incident of pressure ulcer was not significant ( p > 0.05). Thus, it is suggested that these risk factors may not strong predictors of pressure ulcer development. Conclusion This study's result indicated no significant relationship exists between possible identified risk factors and the development of pressure ulcers in HCU patients. However, the Norton and Jackson/Cubbin scales were reliable predictors of pressure ulcer occurrence, with both scales predicting a lower risk of pressure ulcer development.

The Effect of Planned Nursing Care on the Development and Severity of Pressure Ulcers in Elderly Patients: An Interventional Study

Introduction: Pressure ulcer is one of the common problems in hospitals, especially in long-stay inpatient departments and intensive care units. This study was conducted with the aim of investigating the effect of planned nursing care on the occurrence and severity of pressure ulcers in patients admitted to the intensive care units. Methods: In this interventional study, 80 patients were gradually placed in two control and experimental groups. The participants of the experimental group received the care plan based, while the participants of the control group received only the daily and routine care plan. The rate of pressure ulcer development was evaluated based on the scale of the International Pressure Ulcer Society. The data were analyzed using chi-square test and Fisher’s exact test in SPSS version 16 software. Results: The relative and absolute frequency distribution of the research units according to the presence or absence of pressure ulcers after the intervention showed that pressure ulcers in the experimental group decreased significantly (P≤0.05). Also, the difference in the severity of pressure ulcers in the two groups indicated that the intervention reduced the degree, severity, and depth of pressure ulcers. Conclusion: Carrying out planned care in patients who have a high risk of pressure ulcers will reduce the possibility of pressure ulcers, especially with high severity and degree. Therefore, applying the principles of pressure ulcer prevention by the care team is emphasized and recommended for patients who are not able to do this themselves.

Effect of Aloe vera gel versus olive oil in the prevention of pressure ulcers among bedridden patients: A pilot study

Given the high occurrence of pressure ulcers in healthcare settings, this research sought to determine the efficacy of using Aloe vera gel or olive oil to prevent them in bedridden patients. Nurses often work long hours to avoid pressure ulcers, making it critical to investigate alternate remedies. Previous research revealed that Aloe vera gel and olive oil might accelerate pressure ulcer healing by lowering microbial presence and maintaining skin integrity, making them possible preventative strategies. The research included thirty volunteers who were randomly assigned to one of three groups: Aloe vera gel, olive oil, or regular skincare. Over an 11-day period, the efficacy of each therapy in avoiding pressure ulcers was measured using the EPUAP (European Pressure Ulcers Advisory Panel) and Braden scales. Although direct comparison between the two treatment groups was restricted due to the small sample size, the Aloe vera gel and olive oil groups revealed a considerably decreased incidence of pressure ulcers compared to the control group. In conclusion, using olive oil and Aloe vera gel to the skin of bedridden patients showed promise in lowering the incidence of pressure ulcers. More study is needed to validate these results and make herbal treatments essential to preventative skincare practices for skin disorders in hospital settings.

UTILIZATION OF LASSO AND POISSON REGRESSION DEALING WITH COUNT VARIABLES IN NURSING HOME RESEARCH

Abstract Regression has been used for decades; thus, more empirical studies are necessary to choose appropriate regression methods, as traditional regression has many drawbacks and is limited in analysis and synthesis with large numbers of covariates. This study aims to investigate factors related to pressure ulcers in nursing homes using three regressions: least absolute shrinkage and selection operator (LASSO) Poisson, LASSO linear, and LASSO logistic regression. We represent how each model’s estimating, inferencing, and performance measures work. The datasets accrued from 51 nursing homes that operated between 2021 and 2022. A total of 35 independent variables included organizational and nurse staffing variables. The variable of interest was the number of residents in each nursing home who had an occurrence of pressure ulcers within the last 3 months. The significant factors were different; turnover of Certified Nurse Aides and government incentives of more RNs were significant in the LASSO Poison regression, no factors were significant in the LASSO Linear regression, while and the percentage of residents who are completely dependent for activities of daily living in LASSO was significant factor in the Logistic regression. Using the coefficients in the Poisson regression, we interpreted that more nursing staff turnover increased the percentage of residents with pressure ulcers by 3.02 times, which would not be possible with linear regression. The Lasso model uses a technique of shrinking coefficient estimates to zero to improve the fit of a model that includes all explanatory variables and improves model interpretability by identifying most important features.

Impact of fast-track rehabilitation nursing on pressure ulcers and postoperative complications in patients with inter-trochanteric fractures: A meta-analysis.

We sought to investigate the effects of fast-track rehabilitation nursing on pressure ulcers, length of hospital stay and postoperative complications in patients with inter-trochanteric fractures (ITF). The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure and WanFang databases were searched for randomised controlled trials (RCTs) published from inception to September 2023 on the application of fast-track rehabilitative nursing to ITF. Two investigators independently screened the literature and performed data extraction and quality assessments using the Cochrane Risk of Bias Assessment Tool. The meta-analysis was performed using RevMan 5.4. Overall, 22 RCTs involving 1904 patients were included. Meta-analysis revealed that after fast-track rehabilitation nursing intervention in patients with ITF, the occurrence of pressure ulcers (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18-0.47; p < 0.001) and postoperative complications (OR: 0.19; 95% CI: 0.14-0.26; p < 0.001) were significantly reduced and hospital stay was significantly shorter (standardised mean difference: -3.10; 95% CI: -3.82 to -2.38; p < 0.001). Nursing care for patients with ITF based on the concept of fast-track rehabilitation is conducive to reducing the occurrence of pressure ulcers, lowering the occurrence of complications, shortening the length of hospitalisation and promoting postoperative rehabilitation.

Impact of hydrocolloid dressings in the prevention of pressure ulcers in high-risk patients: a randomized controlled trial (PENFUP)

It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among hospitalized high-risk adults. Randomized, parallel-group, open-label, superiority trial with an active control group, blinded for investigators, event validators, and analysts (December 1, 2015 to December 12, 2017). Eligible patients were ≥ 18 years of age with intact skin judged as high-risk for skin ulcers (Braden scale), admitted to surgical or medical wards of two tertiary-level hospitals. Participants were randomized (1:1) to protection with hydrocolloid dressings or petrolatum. The primary outcome was the first occurrence of pressure ulcers (with post-injury photographs adjudicated by three judges) under intention-to-treat analysis. Based on prior cost analysis, and the available resources (assumed incidence of 6 ulcers/1000 patient-days in controls), inclusion of up to 1500 participants allowed to surpass a one-sided superiority threshold > 5% based on a target efficacy > 40% for dressings. We planned an economic analysis using a decision tree model based on the effectiveness of the study results from a perspective of the third payer of health care. After inclusion of 689 patients (69 events), the trial was stopped for futility after a planned interim analysis (conditional power < 0.1 for all scenarios if the trial was completed). Pressure ulcers had occurred in 34 (10.2%) patients in the intervention group [9.6 per 1000 patient-days] and 35 (9.9%) participants in the control group [7.9 per 1000 patient-days], HR = 1.07 [95% CI 0.67 to 1.71]. The estimated incremental cost for dressings (a dominated strategy) was USD 52.11 per patient. Using hydrocolloid dressings was found similar to petrolatum for preventing pressure ulcers among hospitalized high-risk patients. As it conveys additional costs, and in this study was unlikely to demonstrate enough superiority, this strategy did not overcome conventional skin care.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT02565745 registered on December 1, 2015.

Effects of excretion care with a smart automatic defecation treatment system on skin humidity, Incontinence-Associated Dermatitis, and pressure ulcers of patients with incontinence residing in long-term care facilities: Non-equivalent control group non-sy

This study investigated the effects of excretion care using a smart automatic defecation treatment system on skin humidity, pressure ulcer (PU) occurrence, and severity of Incontinence-Associated Dermatitis (IAD) among patients with incontinence residing in long-term care facilities. Each patient in the experimental group was fitted with a smart automatic defecation treatment system. The system detected the release of urine/stool via a built-in sensor, followed by suction, cleaning with a water jet, and drying with warm air. Incontinence management for the control group involved the use of wet wipes for cleaning and changing diapers. The nursing interventions lasted for 2 weeks, and data were collected at baseline, week 1, and week 2. Descriptive statistics, t-tests, and the repeated-measures analysis of variance were used for data analysis. The analysis revealed statistically significant differences in skin humidity and IAD between the experimental and control groups. This study is pertinent because it demonstrated the positive effects of excretion care using a smart automatic defecation treatment system on skin humidity, PU risk, and IAD among patients with incontinence residing in long-term care facilities. Further research is necessary to investigate additional factors such as pressure and physiological traits.

Retrospective study of occurrence of pressure ulcers among the patients admitted in rural tertiary care hospital and their outcome

This retrospective study addresses the pivotal role of pressure ulcer prevention in evaluating the quality of care within critical care units. The incidence of pressure ulcers serves as a crucial indicator, impacting patient recovery and complicating treatment. In this data based retrospective study we assessed the prevalence of pressure ulcers for a duration of 6 years. In this data we included the patients from surgical, medical, respiratory and cardiac critical care units who were admitted between 01/06/16 to 01/06/22. All male and female patients aged above 18 years were included. Patients who got discharge within 48 hours were excluded. Total of 35 patients were noted to have bedsores in intensive care unit from June 2016-June 2022 admitted under both medical and surgical branches. Out of which 34.3% were in age group above 70yrs where 87.9% were male patients. Most commonly 1-2 bedsores (97.1%) were present involving mostly buttock area (82.9%) of 2-5cm size (45.7%). Most of the patients admitted under medical branch developed bedsores more often than surgical branch and appeared after admission (77.1%) with 15-30 days hospital stay (31.4%). This study has illuminated our path forward in improving patient care and preventing pressure ulcer development among patients admitted to our medical and surgical Intensive Care Units in our Rural Tertiary hospital. The findings have paved the way for targeted interventions, underlining our commitment to raising the standard of care for our critically ill patients.

Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study.

Our aim was to measure the effectiveness of home healthcare pressure ulcer (PU) prevention devices (PUPDs) for at-risk patients after hospital discharge in France. We conducted a retrospective analysis of PU-associated hospitalisations based on the French medico-administrative database (Système National des Données de Santé, SNDS), which covers the entire French population. All adults >70 years of age, hospitalised from 1 July to 31 December 2015, and equipped with a medical bed at home, were included. Follow-up was for a maximum of 18 months. Propensity score matching allowed the comparison of PUPD equipped and non-equipped groups (No-PUPD), considering sociodemographic characteristics and other factors. The study included 43,078 patients. Of this population, 54% were PUPD patients and 46% No-PUPD. After matching, PUPD patients had significantly fewer PUs than No-PUPD patients (5.5% versus 8.9%, respectively; p<0.001). The adoption of PUPD reduced by 39% the risk of a PU in hospital. Patients equipped within the first 30 days at home after hospitalisation had fewer PUs than those equipped later (4.8% versus 5.9%, respectively). The estimated PUPD use costs represented 1% of total healthcare expenditure per patient during the study period. The study results demonstrated the effectiveness of the adoption of mattress toppers or prevention mattresses in reducing PU occurrence in patients aged >70 years of age. A short delay in PUPD delivery appeared to have a real impact in the medical setting. Future research on a larger population might provide more evidence on the appropriate support and timeframe to choose based on risk assessment.

Impact of a new clinical mattress solution on interface pressure and comfort during supine lying.

Effective pressure management for individuals is critical for hospital and community-based care, to prevent the occurrence of pressure ulcers. This study explores the impact of a new mattress and topper solution on interface pressure and comfort during supine lying. In this quantitative, healthy cohort study, patient-surface interface pressures were calculated for three mattresses (a standard hospital mattress, a new mattress solution (Levitex Foams Ltd., UK) and a dynamic air flow mattress) with and without an innovative topper solution (Levitex Foams Ltd., UK). Subjective comfort, contact surface area, peak and mean pressure and peak pressure index (head, sacrum, heels) were calculated for all mattress conditions for a 21-minute period. A total of 27 healthy volunteers took part in this study. The new mattress solution decreased peak pressure significantly compared with the hospital and air mattresses (p<0.04). Lower peak pressures were observed for the hospital mattress compared with the dynamic air flow mattress. The new mattress solution improved comfort and significantly lowered (>30%; p≤0.005) heel and head pressure compared with the other surfaces. Both hospital and air mattresses significantly reduced pressure and improved comfort with the addition of the new topper solution (p<0.05). The new mattress solution used in this study offers a potentially improved pressure management solution for individuals. Implementation of the topper may also help to improve pressure management when used with existing standard or dynamic air flow mattresses.

Design and application of a kind of anti-bedsore turning pad

Patients who are bedridden are for a long-time prone to develop bedsores, especially in the hip and sacral areas and limbs, which causes eczema, ulcers, infection and other complications, resulting in pain and more medical costs. Therefore, the medical staff of the Second Affiliated Hospital of Zunyi Medical University designed and developed a kind of anti-bedsore turning pad, and has obtained the national utility model patent (ZL 2021 2 3004923.9), which is suitable for various long-term bedridden patients. The anti-bedsore turning pad includes the center axis of the turning pad, and ventilation pad 1 and ventilation pad 2 designed on the left and right of turning pad center axis. Under the ventilation pad 1 and the ventilation pad 2, the air pad 1 and the air pad 2 are respectively designed. There is a bedspread connected with ventilation pad 1 and ventilation pad 2 on the inflatable pad 1 and the inflatable pad 2. Through the design of inflatable pad 1 and inflatable pad 2, the left and right of the anti-bedsore turning pad can be lowered or raised independently, which is convenient for the patient's body to tilt and turn over, and can significantly reduce the number of nursing staff and the burden of nursing staff when turning over. In addition, it is convenient to replace the force site at any time and reduce the occurrence of pressure ulcers caused by long-term pressure on the force site. Through the design of ventilation cushion 1 and ventilation cushion 2, the internal gas flow of the turning pad can be made, and the ventilation between the patient and the turning pad can be kept dry, so as to reduce the occurrence of eczema, ulcers or infection and other complications, and ultimately reduce the occurrence of bedsores. In addition, through the design of the most superficial limb pad, the patient's limb can be appropriately elevated or massaged, which increases the comfort of the patient. The anti-bedsore turning pad is simple and effective, and can be widely used in long-term bedridden patients.

Automatic Controlled Pressure Sensor to Prevent Pressure Ulcer Obtained For Prolonged Hospitalization

The prototype model presented in this paper proposes a solution for evaluating and preventing pressure ulcers in long-lasting bedridden patients. The system integrates various sensors capable of monitoring critical factors such as pressure, temperature, and moisture. These sensors are embedded within the prototype bed, allowing for the collection of real-time data concerning the patient's condition and identification of potential risk factors associated with pressure ulcer development. The bed is equipped with switches that facilitate the monitoring of the patient's mobility and activities. These switches can detect movements, providing valuable information on changes in posture, frequency of turning, and overall activity level. Through data analysis, the system can assess the probability of pressure ulcer occurrence, taking into account factors such as prolonged pressure on specific areas, excessive moisture levels, or extreme temperatures. This prototype model shows significant promise in preventing pressure ulcers among long-lasting bedridden patients. Continuous monitoring of the patient's physiological parameters and activity levels enables healthcare providers to receive timely alerts and intervene appropriately to mitigate the risk of pressure ulcers. Additionally, the system can generate informative reports and offer valuable insights into the patient's condition, assisting healthcare professionals in making informed decisions regarding patient care and preventive measures. Overall, this prototype model provides a comprehensive approach to evaluating and preventing pressure ulcers in long-lasting bedridden patients. By leveraging sensor technology and real-time data analysis, it has the potential to improve patient outcomes, enhance the quality of care, and reduce the incidence of pressure ulcers in this vulnerable population.

Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. ObjectivesTo compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. MethodsMulticenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. ResultsA total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55−74) and BMI 30.7 (RIC 27−34.2). Median ICU stay was 28 days (IQR 17−44.2), median hours on PD per patient 48 h (IQR 24−96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). ConclusionsThe incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

Assessment on Application Effect of Intelligent Pressure Ulcer Information Management System Software.

We aimed to apply the intelligent pressure ulcer information management system software to hospitalized patients with pressure ulcer and to evaluate its application effect. Fifty patients hospitalized in the Third Xiangya Hospital of Central South University, Changsha, China, a grade-A tertiary hospital from March 2021 to May 2021 were grouped into the control group. For these subjects, conventional electronic forms were used to report and manage pressure ulcer information. Another 50 patients with pressure ulcer were selected as the experimental group who were hospitalized the same hospital from June 2021 to August 2021. They were managed with Intelligent Pressure Ulcer Information Management System Software. The effects of the two management methods were assessed by comparing the reporting time, the degree of pressure ulcer healing 1 week after the occurrence of pressure ulcer and after discharge, and the nurse satisfaction. The reporting time and Design-R scores 1 week after the occurrence of pressure ulcer and after discharge were significantly lower than those of the control group (P<0.05). The pressure ulcer information management system makes the reporting process simple and convenient, which saves the reporting time, improves the accuracy of the pressure ulcer staging. It achieved the guidance for various stages of pressure ulcer treatment program, the use of dressing guidance, improved the accuracy of pressure ulcer treatment program, which is worthy of clinical reference.

Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors

To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p<0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.

The paradox of obesity in pressure ulcers of critically ill patients.

The relationship between body mass index and pressure ulcers in critically ill patients is controversial. We aimed to investigate the association between body mass index and pressure ulcers by analysing data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Eligible data (21 835 cases) were extracted from the database (2008-2019). The association between body mass index and pressure ulcers in critically ill patients was investigated by adjusting multivariate trend analysis, restricted cubic spline analysis, and segmented linear models. Subgroup analyses and sensitivity analyses were used to ensure the stability of the results. Trend analysis and restricted cubic spline analysis showed an approximate U-shaped correlation between body mass index and the occurrence of pressure ulcers in critically ill patients, with the risk of pressure ulcers decreasing rapidly with increasing body mass index (8.6% decrease per unit) after adjusting for relevant factors; the trend reached its minimum at a body mass index of 27.5kg/m2, followed by a slow increase in the risk of pressure ulcers with increasing body mass index (1.4% increase per unit). Among the subgroups, the highest overall risk of pressure ulcers and the risk of severe pressure ulcers were significantly higher in the underweight group than in the other subgroups, and the risk associated with the overweight group was the lowest. There is a U-shaped association between body mass index and pressure ulcers in critically ill patients, and being underweight and obese both increase the risk of pressure ulcers. The risk is highest among underweight patients and lowest among overweight patients (but not patients of normal weight), necessitating targeted prevention strategies for critically ill patients with different body mass indexes.

Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. ObjectivesTo compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. MethodsMulticenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. ResultsA total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p=0.002), location (p<0.001) and median duration of hours per PD episode (p=0.001). ConclusionsThe incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.