Pressure Injuries In Adult Patients Research Articles

Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial

BackgroundPressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from. ObjectivesAssess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients. MethodsUsing a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data. ResultsFrom May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing. ConclusionsA larger trial is feasible with minor refinement to the length of stay eligibility criterion. Implications for practiceProphylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.

Intensive Care Pressure Injuries: A Cohort Study Using the CALCULATE and Braden Scales.

Identify both the risk of developing pressure injuries (PIs) by applying the CALCULATE (CriticAL Care pressure ULcer Assessment Tool made Easy) and Braden Scales and the incidence of PIs in adult patients in intensive care. This prospective cohort study was conducted from March 2016 to February 2017 in an adult ICU. The Braden and CALCULATE scales were applied every 48 hours until medical discharge, death, or PI development. The sample included 100 patients. The investigators obtained 818 evaluations (409 Braden and 409 CALCULATE) with an average of 4.1 observations per patient. According to the CALCULATE scale, 49 participants (49%) were classified as very high risk, compared with 40 participants (40%; P = .204) according to the Braden Scale. Thirty-five patients developed 37 PIs, with a total incidence of 35%. The mean age of patients who developed PIs was 60.3 (SD, 13.7) years, and they averaged 9.2 (SD, 6.8) days of hospitalization, with diagnoses related to cardiorespiratory and neurologic diseases and associated comorbidities of hypertension, diabetes mellitus, and smoking. The most affected site was the sacral region; 64.9% of the injuries were classified as stage 1. Patients in intensive care were high risk according to both PI scales, and many developed PIs. It is evident that even when preventive measures are used, they are insufficient without the implementation of preventive protocols.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis.

Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals’ evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.

Efeito da terapia a laser no tratamento de lesões por pressão em pacientes adultos: revisão integrativa

A lesão por pressão se caracteriza por um dano na pele resultante de uma pressão intense ou prolongada. O Brasil apresenta altas taxas de incidência de lesão por pressão em pacientes internados, o que torna a terapia a laser uma alternativa de tratamento adjuvante para a reparação tecidual. O presente estudo teve como objetivo analisar a efetividade da terapia a laser de baixa potência no tratamento de lesões por pressão em pacientes adultos. Trata-se de uma revisão integrativa com oito artigos selecionados nas bases de dados Lilacs, Pubmed e Medline entre o período de 2010 e 2020. Após a leitura, análise e interpretação dos dados, pode-se verificar que, apesar de haver poucos estudos recentes sobre a terapia a laser na temática da lesão por pressão, os artigos elucidam o uso do laser como uma modalidade promissora de tratamento, que proporciona redução do tempo de cicatrização e melhora no aspecto das feridas. Contudo, os estudos apresentam distintos parâmetros de aplicação, comprimentos de onda, densidade de energia e frequência de tratamento, o que impossibilita um consenso entre os autores sobre a técnica de aplicação do laser. Há a necessidade de novas pesquisas para criar e elucidar padronizações ou protocolos, a fim de otimizar a qualidade de atendimento aos pacientes portadores de lesão por pressão e promover a divulgação da terapia a laser como um tratamento seguro e efetivo.