Pressure Injury Development Research Articles

The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle

Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.

Community-Acquired Pressure Injuries: Prevalence, Risk Factors and Effect of Care Bundles-An Integrative Review.

To summarise the evidence and present the state of the science on pressure injury care bundles in the community. Specifically, this review examined (i) the extent of pressure injury by studying its prevalence and incidence in the last 10 years, (ii) the risk factors associated with community-acquired pressure injury and (iii) the components and outcomes associated with effective pressure injury care bundles in the community. PI care bundles have effectively reduced PI rates; however, there is limited evidence of care bundles used in community settings. Integrative review. This integrative review is guided by the Whittemore and Knafl framework and follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aims were extracted, and findings were synthesised and presented. PubMed, Medline, CINAHL and Web of Science were searched. Studies published in the English language between 2012 and 2022 were retrieved. A total of 89 articles were retrieved; 25 met the inclusion criteria. Most studies reported the point prevalence and period prevalence of community-acquired pressure injuries, and only one study reported the incidence of community-acquired pressure injuries. The point prevalence and period prevalence of community-acquired pressure injury were 0.02% to 10.8% and 2.7% to 86.4%, respectively, and the cumulative incidence was 1.3%. The risk factors for community-acquired pressure injury assessed vary between studies; older age, poor nutrition, immobility and multiple comorbidities are commonly reported. Socioeconomic and caregiving factors were not studied. Very few studies evaluated pressure injury care bundles in the community. Even so, the components of the pressure injury care bundle vary between studies. Pressure injury development is associated with a complex interplay of factors. Socioeconomic and caregiving factors were not examined in any of the papers. There is a lack of understanding of the components and outcomes associated with effective pressure injury care bundles in the community. Despite their prevalence, community-acquired pressure injuries (CAPIs) are often underreported due to inadequate follow-up and reporting mechanisms. Although the risk factors for CAPIs vary across studies, older age, impaired mobility, multiple comorbidities and malnutrition consistently emerge as key contributors. Pressure injury preventive care bundles are more commonly used in the acute care setting rather than the community setting. No Patient or Public Contribution.

Incidence, characteristics and risk factors of endotracheal tube-related pressure injuries in intensive care units.

Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. This study investigated the incidence of, characteristics of and risk factors for ETT-related pressure injuries for ICU patients. This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube-Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. The study revealed that 80.14% of the patients developed ETT-related pressure injuries. Over half of the ETT-related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT-related pressure injuries (OR: 1.15, 95% CI: 1.05-1.26, p = .003). None of the other variables were statistically significant in the development of pressure injuries. The incidence of ETT-related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT-related pressure injuries. Intensive care nurses should implement interventions to prevent ETT-related pressure injuries in critically ill patients receiving mechanical ventilation support. ETT-related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT-related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT-related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used.

Prevalence and Risk Factors of Pressure Injury in Home Care Patients

The present study aimed to determine the prevalence of pressure injury in home care patients and the risk factors that affected its occurrence. The study was conducted in a descriptive-cross-sectional design to 6 months between November 2021 and May 2022 with 170 home care patients who were registered to the Home Health Care Service at a public hospital a city western in Turkey and met the inclusion criteria. The data were collected with the in-person interview method by using the investigator-created Patient Evaluation Form, National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System, and Glasgow Coma Scale (GCS). The prevalence of pressure injury was found to be 33.5% in the study. The prevalence of pressure injury was statistically and significantly higher in the patients younger than 75 years of age ( p = .043), underweight, and with normal Body Mass Index (BMI) ( p = .009). The prevalence of pressure injury was found to be lower in those who were oriented according to GCS ( p = .000). No statistically significant differences were detected between the presence of pressure injury and gender, education levels, marital status, income status, presence of systemic or chronic disease, continuous medication use, type of medication used, and duration of receiving home care services ( p > .05). The results of the present study showed that the prevalence of pressure injury was high in home care patients and that age, BMI, and level of consciousness variables were factors that influenced the development of pressure injury.

A Predictive Model of Pressure Injury in Children Undergoing Living Donor Liver Transplantation Based on Machine Learning Algorithm.

The aim of our study was to formulate and validate a prediction model using machine learning algorithms to forecast the risk of pressure injuries (PIs) in children undergoing living donor liver transplantation (LDLT). A retrospective cohort study. The research was carried out at China's largest paediatric liver transplantation centre. A total of 438 children who underwent LDLT between June 2021 and December 2022 constituted the study cohort. The dataset was partitioned randomly into 70% for training datasets (306 cases) and 30% for testing datasets (132 cases). Utilising four machine learning algorithms-Decision Tree, Random Forest, Gradient Boosting Decision Tree and eXtreme Gradient Boosting-we identified risk factors and constructed predictive models. Out of 438 children, 42 developed PIs, yielding an incidence rate of 9.6%. Notably, 94% of these cases were categorised as Stage 1, and 54% were localised on the occiput. Upon evaluating the four prediction models, the Decision Tree model emerged as the most effective. The primary contributors to pressure injury in the Decision Tree model were identified as operation time, intraoperative corticosteroid administration, preoperative skin protection measures and preoperative skin conditions. A visualisation elucidating the logical inference process for the 10 variables within the Decision Tree model was presented. Ultimately, based on the Decision Tree model, a predictive system was developed. Machine learning algorithms facilitate the identification of crucial factors, enabling the creation of an effective Decision Tree model to forecast pressure injury development in children undergoing LDLT. With this predictive model at their disposal, nurses can assess the pressure injury risk level in children more intuitively. Subsequently, they can implement tailored preventive strategies to mitigate the occurrence of PIs. Paediatric patients contributed electronic health records datasets.

Risk Factors Related to the Development of Full-thickness Pressure Injuries in Hospitalized Pediatric Patients.

Current pediatric pressure injury (PI) prevention measures are based on risk factors related to PI development in adults. Children offer a unique concern for PI development because their bodies are still developing, and their skin responds differently to external pressure. To explore risk factors for the development of full-thickness PIs in children aged 21 weeks' gestation to 21 years. This retrospective, observational, correlational study included 799 hospitalized children who developed a PI. The pediatric and adult PI risk factors used in the study were identified from the International Pressure Ulcer Prevention and Treatment Guideline. A stepwise multivariate logistic regression model was used. Multivariate analyses revealed that risk factors for predicting a full-thickness PI varied by age. For children aged 38 weeks to 12 months, risk factors included tissue perfusion and oxygenation: generalized edema, conditions of the OR, and nutrition deficits. For children aged 1 to 7 years, fragile skin status was a risk factor. For youth aged 8 to 21 years, the two risk factors were tissue perfusion and oxygenation: decreased oxygenation and extracorporeal membrane oxygenation. Across the total sample, extracorporeal membrane oxygenation, tissue perfusion and oxygenation: decreased oxygenation and malnutrition were risk factors for predicting a full-thickness PI. Full-thickness PI risk factors differ among the ages of pediatric patients.

The Effect of Aloe Vera and Honey Dressings on Preventing Pressure Injuries in High-Risk Elderly ICU Patients: A Randomized Clinical Trial

Background: Today, due to the challenging treatment of pressure injuries, the preferred approach is prevention and care. One preventive measure is the use of specialized dressings, although very few studies have explored this area. Objectives: This study aimed to investigate the impact of using aloe vera and honey on the prevention of pressure injuries among elderly patients admitted to an intensive care unit in Qazvin, Iran, in 2022. Methods: In this randomized, single-blind clinical trial, 90 elderly patients at moderate to high risk of developing pressure ulcers were divided into three groups. Each group received a different preventive dressing on their sacral area twice a day for one week: The first group received aloe vera gel, the second group received honey, and the third group received plain gauze. Data were collected using a demographic information checklist, the Braden scale for predicting pressure injury risk, and a pressure injury grading tool. The data were analyzed using descriptive and analytical statistical tests and statistical software. Results: The mean Braden scale scores for patients in the aloe vera, honey, and simple dressing groups were 10.83 ± 1.41, 10.40 ± 1.52, and 10.30 ± 1.55, respectively (P = 0.40). Ten patients developed pressure injuries (0 in the aloe vera group, 3 in the honey group, and 7 in the simple dressing group). A statistically significant difference was found in the occurrence of pressure injuries between the aloe vera and honey groups compared to the control group (P = 0.015). Conclusions: The study revealed that aloe vera preventive dressing had a significant and favorable effect on pressure injury prevention. Further studies are recommended to validate these findings.

Development of pressure injuries in individuals dmitted to the ICU: integrative review

Development of pressure injuries in individuals dmitted to the ICU: integrative review

Prevalence and incidence of pressure injuries among nursing home residents with darker skin tones: A prospective cohort study.

To measure the prevalence and incidence of nursing home-acquired pressure injuries in older adults residing in Sri Lankan nursing homes. Pressure injury prevalence and incidence are indicators of safety and quality of care. A significant portion of the global population has a skin color dominated by the presence of melanin. Yet, the number of nursing home residents with darker skin tones who develop pressure injuries in nursing homes is relatively unknown. Prospective multisite cohort study conducted in nine nursing homes in Sri Lanka. The sample comprised 210 residents aged ≥60 years old. Semi structured observations and chart audits were used to gather data from July to October 2023. Head-to-toe visual skin assessment to check for nursing home- acquired pressure injuries, Braden pressure injury risk scale and Fitzpatrick skin tone assessments were conducted on all recruited residents at baseline. All recruited residents were followed-up weekly for 12 weeks until detection of a new pressure injury, death, discharge, or transfer. Pressure injury point prevalence at baseline was 8.1% (17/210). Cumulative incidence was 17.1% (36/210). Incidence density was 15.8 per 1000 resident weeks. Most nursing home-acquired pressure injuries were located on the ankle at baseline (29.4%; 5/17) and in the follow-up period (27.8%; 10/36). Stage I pressure injuries were most common: 58.8% (10/17) and 44.4% (16/36) at baseline and during follow-up respectively. About one in six nursing home residents developed a new pressure injury over the 12-week follow-up period. Despite staff and resource constraints, there remains a need to focus on the prevention of pressure injuries in Sri Lankan nursing homes. Studies on the burden of pressure injuries among darker skin tone nursing home residents are lacking and the current evidence available are predominantly from Western countries. The findings of this study highlight the need of targeted preventive measures for nursing home residents with darker skin tones.

Antihypertensive effects of whey protein hydrolysate involve reshaping the gut microbiome in spontaneously hypertension rats

Novel angiotensin-converting enzyme (ACE) inhibitory peptides were identified from whey protein hydrolysates (WPH) in vitro in our previous study and the antihypertensive abilities of WPH in vivo were further investigated in the current study. Results indicated that WPH significantly inhibited the development of high blood pressure and tissue injuries caused by hypertension. WPH inhibited ACE activity (20.81 %, P < 0.01), and reduced renin concentration (P < 0.05), thereby reducing systolic blood pressure (SBP) (12.63 %, P < 0.05) in spontaneously hypertensive rats. The increased Akkermansia, Bacteroides, and Lactobacillus abundance promoted high short chain fatty acid content in feces after WPH intervention. These changes jointly contributed to low blood pressure. The heart weight and cardiomyocyte injuries (hypertrophy and degeneration) were alleviated by WPH. The proteomic results revealed that 19 protein expressions in the heart mainly associated with the wingless/integrated (Wnt) signaling pathway and Apelin signaling pathway were altered after WPH supplementation. Notably, WPH alleviated serum oxidative stress, indicated by the decreased malondialdehyde content (P < 0.01), enhanced total antioxidant capacity (P < 0.01) and superoxide dismutase activity (P < 0.01). The current study suggests that WPH exhibit promising antihypertensive abilities in vivo and could be a potential alternative for antihypertensive dietary supplements.

Determination of the family caregivers’level of knowledge on pressure injury prevention

ObjectiveThe purpose of this study is to determine family caregivers’ level of knowledge on pressure injury (PI) prevention. MethodsThis study used a cross-sectional and descriptive design. Data were collected between February and May 2023. The population of the study consisted of family caregivers providing care to patients who were at risk of developing pressure injuries and who were planned to be discharged from the inpatient wards of the hospital. A total of 105 family caregivers participated in the study. ResultsOf all the patients, 61.9 % (n = 65) were female and their average age was 68.96 years (SD = 18.07). While 30.48 % (n = 32) of the patients were bedridden due to Cerebrovascular Accident, 28.57 % (n = 30) were bedridden due to old age, and 28.57 % (n = 30) had PI. Of all the caregivers, 71.43 % (n = 75) were female, and their average age was 47.11 years (SD = 14.85). While 97.14 % (n = 96) of the caregivers had not received any training on PI before, 90.48 % (n = 95) had not provided care to a patient with PI before. Family caregivers scored an average of 22.25 (SD = 6.96) points out of 40 on the Pressure Injury Prevention Knowledge Test (PIPKT). A significant difference was detected between the knowledge test scores and education level and income level (P = 0.006; P = 0.002). ConclusionsFamily caregivers were found to need information about PI prevention. It is recommended to develop content on PI prevention in the guidelines for family caregivers.

Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study.

Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. Multicentre prospective cohort study. Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. The study followed TRIPOD guidelines. The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.

Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients.

To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients. This research used a comparative design. One hundred thirty elderly patients participated in the study. The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner. The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively. The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.

NURSES ROLES IN THE MANAGEMENT OF PRESSURE INJURY

Pressure injury, also referred to as pressure ulcers or bedsores, are debilitating wounds that develop when prolonged pressure is applied to the skin, resulting in localized tissue damage and compromised blood flow. These injuries often occur in areas where bony prominence come into contact with surfaces such as beds, chairs, or medical devices. The National Pressure Injury Advisory Panel (NPIAP) defines pressure injury as "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction." This definition highlights the multi-factorial nature of pressure injury development, which can involve not only pressure but also shear forces and friction. The importance of managing pressure injury cannot be overstated, as they pose significant health risks and can lead to serious complications if left untreated.More importantly, pressure injury can impair mobility, hinder rehabilitation efforts, and prolong hospitalization, resulting in increased healthcare costs and diminished quality of life. Pressure injury is the third most expensive disorder after cardiovascular diseases and cancer (Agrawal &amp; Chauhan, 2012 as cited in Nkor M.M.,2022). Objectives : the objectives of this study includes , identification of various risk factors influencing the development of pressure injury, outlining assessment techniques for pressure injury, standardized tools used for pressure injury assessment, stages of pressure injury, nursing interventions for pressure injury and evidence base wound care techniques for various stages. Summary: In summary, pressure injuries remain a significant healthcare challenge, particularly for individuals with limited mobility or underlying health conditions. Effective prevention, assessment, and management of pressure injuries require a multifaceted approach that incorporates evidence-based practices, interdisciplinary collaboration, and patient-centered care.

Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial.

Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. Currently, 6 participants have been recruited for our aim-1 qualitative study. This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. DERR1-10.2196/51849.

Difficulties and obstacles experienced by intensive care unit nurses during the prevention and care of pressure injuries: A qualitative study

AimThis study aimed to examine the difficulties and obstacles experienced by nurses working in intensive care units during the prevention and care of pressure injuries (ulcers). Materials and methodsA descriptive phenomenological study was designed, involving 13 nurses working in the intensive care unit of a hospital in Turkey. The data were collected through face-to-face interviews. The data were analyzed using thematic analysis. The findings were reported according to the Consolidated Criteria for Reporting Qualitative Studies criteria. ResultsThrough the data analysis, an overall theme “Prevention and Care of Pressure Injuries” and three main themes, namely “Obstacles Encountered”, “Impacts on The Nurses”, and “Needs and Recommendations” were identified. ConclusionThis study identified institution-related issues (lack of resources, managers’ attitudes, etc.), as well as lack of knowledge and training prevent the effective management of pressure injuries in intensive care units. The development of pressure injuries emotionally and professionally affects nurses. The primary needs of nurses were found to be equipment and material support, personnel training, positive attitudes of institution managers, and the establishment of a wound care unit within the hospital. The following recommendations were made based on the obtained findings: practical training should be given to all intensive care unit teams based on the latest information, modern, practical, diverse, and sufficient amount of equipment for pressure injuries should be provided, personnel shortage should be eliminated, institution managers should exhibit solution-oriented attitudes toward nurses rather than accusatory approaches, and a wound care unit should be established within the hospital. This study was limited to the nurses working in the ICU of a state hospital in Turkey. Since the study was carried out in a single hospital and due to the personal characteristics of the participants, the findings cannot be generalized to all ICU nurses and healthcare institutions.

The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Can a prolonged healing pressure injury be benefited by using an AI mattress? A case study

BackgroundPressure injuries are a common and serious issue for bedridden residents in long-term-care facilities. Areas of bony prominences, such as the scapula, sacrum, and heels, are more likely to develop pressure injuries. The management of pressure injury wounds include dressing changes, repositioning, away from moisture, decreasing the occurrence of friction and shear, and more. Some supportive surfaces are also used for pressure injury cases such as gel pads, alternating pressure air mattresses, and air-fluidized beds. The aim of this case study was to determine whether the use of an artificial intelligent mattress can improve a nursing home resident with prolonged pressure injury.Case presentationA retrospective study design was conducted for this case study. A 79-year-old male developed a pressure injury in the sacrum. His pressure injury was initially at stage 4, with a score of 12 by the Braden scale. The PUSH score was 16. During 5.5 months of routine care plus the use of the traditional alternative air mattress, in the nursing home, the wound stayed in stage 3 but the PUSH score increased up to 11. An artificial intelligence mattress utilizing 3D InterSoft was used to detect the bony prominences and redistribute the external pressure of the skin. It implements a color guided schematic of 26 colors to indicate the amount of pressure of the skin.ResultsThe wound size was decreased and all eczema on the resident’s back diminished. The PUSH score was down to 6, as the artificial intelligent mattress was added into the routine care. The staff also reported that the resident’s quality of sleep improved and moaning decreased. The hemiplegic side is at greater risk of developing pressure injury.ConclusionsThis novice device appeared to accelerate wound healing in this case. In the future, more cases should be tested, and different care models or mattress can be explored.

Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the intensive care unit.

Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points). The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.

The effect of vasopressor agents on pressure injury development in intensive care patients

BackgroundVasopressors are life-saving agents that increase mean arterial pressure. The pharmacodynamic features of these agents and previous studies suggest that vasopressors may be an essential risk factor in developing pressure injuries. ObjectiveThis study aimed to examine the effect of vasopressors in medical-surgical intensive care patients on pressure injury development. Design and settingsThis retrospective and correlational study was conducted between March 2021- May 2022. The electronic patient data were obtained from 148 surgical and medical patients exposed to vasopressor agents in the intensive care unit. Data on patients' demographic and clinical characteristics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Logistic regression modelling was used to assess independent relationships with pressure injury risk; results are reported as odds ratios (OR) and 95% confidence intervals (CI). ResultsAll patients were given norepinephrine agents, and dopamine infusion secondary to norepinephrine was found in only 28.3 % of patients (n = 42). Pressure injury incidence was 43.2 % (n = 64). Duration of norepinephrine infusion was recognized as an independent risk factor for ICU-acquired pressure injury development (OR 1.22, 95 % CI 1.11–1.35), while a medical admission diagnosis (instead of surgical) was protective against pressure injury risk (OR 0.24, 95 % CI 0.10–0.59). ConclusionThis study indicated that duration of norepinephrine infusion is a significant risk factor for pressure injury development. Implications for clinical practiceAlthough norepinephrine use cannot be avoided entirely, its administration may be an early warning for nurses to increase pressure injury prevention strategies. Skin evaluation should be performed more frequently, and preventive strategies should be implemented meticulously.This study was registered on clincialtrials.gov (Identifier: NCT06163352)