Pressure Ulcer Staging Research Articles

Availability and Types of Pressure Ulcer Medications at Community Pharmacies in the Accra Metropolis of Ghana.

Pressure ulcers (PU) arise from prolonged pressure on the skin and underlying tissue due to pathological changes in blood flow. They usually develop in people who are immobilized due to certain medical conditions. The incidence of chronic diseases such as cancer, cardio-vascular diseases are on the ascendency. These conditions, if not managed adequately could render patients incapacitated, leaving them bedridden for long periods. The chances of these individuals developing PU are very high. Currently in Ghana, information on medications for the management of various stages of PU are not readily available. Prevention of PU has been the goal of nursing care, however, in the case where preventive care is not successful, there should be effective and efficient medications for the management of the PU. Method: The study design was descriptive cross-sectional. To get a good representation of the availability of PU medications in the entire metropolis, a stratified sampling approach was used. The 10 districts within the metropolitan area were taken as the strata. Towns within each district were identified, and mapped out. From each town, community pharmacies were randomly selected. It was ensured that pharmacies selected were well spread out (located distance apart). Researchers had to collect data from three or more pharmacies from each town. Data was collected using a structured questionnaire from pharmacists working in these pharmacies. By this approach, the availability of PU medications across the entire metropolitan area was revealed. Results: 241 pharmacies were visited, out of which 192 respondents took part in the study. Approximately 83.3% of these pharmacies had pressure ulcer medications. Majority of the medications available in the community pharmacies visited were hydrophobic based dressings., while hydrophilic based dressings were less than 1%. Implying that patients having PU that produce scopious exudate will have challenges acquiring the necessary dressings to manage the wounds. The dressings which were mostly available, had other indications apart from Pressure Ulcer. Patronage of the available PU medications in the Accra metropolis was average. Conclusion: There are pressure ulcer medications available in pharmacies within the Accra metropolis of Ghana. Although the medications are averagely patronized, there are not many types available. Hydrophilic based dressings were not readily available.

Nutritional status and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases in 2023

A cross-sectional study was conducted at the Ho Chi Minh City Hospital Rehabilitation – Professional Diseases from February to May 2023 to describe nutritional status and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases in 2023. The study focus on the prevalence of malnutrition and the relationship between malnutrition status based on SGA with demographic characteristics, pathology, and clinical laboratory parameters in inpatients with pressure ulcers at the hospital. The study results showed that the prevalence of malnutrition using the SGA method was 92.7%, while using anthropometric BMI was 15.6%. There was a statistically significant difference in the prevalence of malnutrition according to SGA with age groups, length of hospital stays, and stage of pressure ulcers (p < 0.05). Malnutrition is a common issue among patients with pressure ulcers, thus early detection of nutritional status is crucial for developing intervention plans, counseling, and individualized nutritional care for patients.

A deep learning based experimental framework for automatic staging of pressure ulcers from thermal images

ABSTRACT Pressure ulcers can be life-threatening, and accurate staging is crucial for proper treatment. Manual methods for ulcer detection and staging are subjective and prone to errors. Since the wound temperature holds valuable and informative data, we propose thermal imaging as a tool to detect the stages of pressure ulcers automatically. This paper implements a deep learning-based framework for the automatic detection and classification of pressure ulcer stages 2–4 using thermal images. 450 thermal images were used to train the classification model. The framework combines ‘R50-FPN’, retrained using transfer learning, for ulcer detection and cropping. An ensemble model is used for ulcer stage classification. The model was trained on a dataset consisting of 68 original images and their augmentations. The proposed method achieves a mAP for object detection of 0.70 and an ulcer stage classification accuracy of 0.9545 during evaluation. Class activation maps were also employed to study the model performance further, indicating that the trained model focuses on the wound periphery and the wound bed for classification. The results show a significant improvement in classification accuracy when compared with related works demonstrating the potential of deep learning-based thermal imaging as an objective method for the automated staging of pressure ulcers.

Diagnosis of Pressure Ulcer Stage Using On-Device AI

Pressure ulcers are serious healthcare concerns, especially for the elderly with reduced mobility. Severe pressure ulcers are accompanied by pain, degrading patients’ quality of life. Thus, speedy and accurate detection and classification of pressure ulcers are vital for timely treatment. The conventional visual examination method requires professional expertise for diagnosing pressure ulcer severity but it is difficult for the lay carer in domiciliary settings. In this study, we present a mobile healthcare platform incorporated with a light-weight deep learning model to exactly detect pressure ulcer regions and classify pressure ulcers into six severities such as stage 1–4, deep tissue pressure injury, and unstageable. YOLOv8 models were trained and tested using 2800 annotated pressure ulcer images. Among the five tested YOLOv8 models, the YOLOv8m model exhibited promising detection performance with overall classification accuracy of 84.6% and a mAP@50 value of 90.8%. The mobile application (app) was also developed applying the trained YOLOv8m model. The mobile app returned the diagnostic result within a short time (≒3 s). Accordingly, the proposed on-device AI app can contribute to early diagnosis and systematic management of pressure ulcers.

Convolutional neural network models for visual classification of pressure ulcer stages (Preprint)

Convolutional neural network models for visual classification of pressure ulcer stages (Preprint)

Analysis of the Current Status of Nurses' Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study.

Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries. To understand the current status of nurses' knowledge of pressure injuries in Shaanxi Province and the factors influencing it. A cross-sectional survey. In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform. 16,599 nurses had a pressure injury knowledge score of (44.32±10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province. Clinical nurses' awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff's awareness through continuing education, tiered training, and other measures.

Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review.

Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.

МОДИФИКАЦИЯ ТАКТИКИ ВЕДЕНИЯ ПАЦИЕНТОВ С ДЕКОМПЕНСАЦИЕЙ ХРОНИЧЕ СКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ ПРИ СИНДРОМЕ СТАРЧЕСКОЙ АСТЕНИИ

Abstract. Introduction. Frailty affects the prognosis of patients suffering from chronic heart failure. This syndrome increases the frequency of hospitalizations, complicates treatment, and increases the patients’ lethality. Managing patients with chronic heart failure requires some strategic modifications, namely, such management should be supplemented with the procedures aimed at correcting geriatric syndromes. Aim. Optimization of management tactics patients with chronic heart failure and frailty syndrome. Materials and Methods. The study included 52 patients with decompensated chronic heart failure and severe or terminal frailty. Patients were divided into 2 groups: 27 people in group 1, where patients were managed in a standard manner for 7 days, and 25 people in group 2 where integrated management was used. Results and Discussion. Patients of the two groups were comparable in lethality (p=0.17). By the 7th day of observation, the groups were comparable in terms of the number of persons with malnutrition syndrome (p=0.73). The patients were comparable in terms of the pressure ulcer stages and of the presence of infectious complications (p = 1.0). The frequency of thromboembolic complications in the study sample was 5.7%. Conclusions. Integrated management may be considered to improve long-term prognosis for the decompensated chronic heart failure patients with frailty, despite the lack of improvement in short-term outcomes.

Multifunctional electrospun polycaprolactone/chitosan/hEGF/lidocaine nanofibers for the treatment of 2 stage pressure ulcers

In this study, a multifunctional nanofiber dressing that can promote antibacterial, analgesic and healing was prepared by electrospinning technology. Hydrophobic polycaprolactone (PCL)/chitosan (CS)/lidocaine hydrochloride (LID) and epidermal growth factor (EGF) were used as scaffold materials and dissolved in trifluoroacetic acid to prepare spinning solution. The morphology of PCEL dressing was observed by scanning electron microscopy. The fiber structure was dense and the average diameter was 297.0 nm. The water absorption capacity test and water contact angle measurement showed that the fiber had good water absorption and hydrophilicity (1302 %, 139.258°). Drug release was 84 % within 60 h. In the results of antibacterial experiment, the dressing showed certain antibacterial properties. The results of cell experiments show that the dressing can promote cell proliferation. In addition, coagulation experiments showed that the dressing could quickly coagulate the blood within 4 min. In addition, PCEL dressing promoted collagen deposition and vascularization through animal models of pressure sores. Therefore, multifunctional dressing can be used as an ideal auxiliary means for the treatment of pressure sores, and it is a promising alternative to chronic wound healing.

Distribution characteristics of pathogens in different stages of pressure ulcers and the therapeutic effect of linear polarized polychromatic light combined with silver sulfadiazine cream.

To investigate the distribution characteristics of pathogens in different stages of pressure ulcers and observe the application of linear polarized polychromatic light (LPPL) combined with silver sulfadiazine cream in treating varying stages of pressure ulcers. This study comprised 88 patients with pressure ulcers who were enrolled in the department of burn and plastic surgery of our hospital from April 2019 to April 2022. The wound exudates from patients were collected, followed by analyzing the distribution of pathogens in different stages of pressure ulcers. Patients were randomly divided into 2 groups. The first group (n = 44) received LPPL combined with silver sulfadiazine. The other group was intervened with LPPL group only for 2 weeks. The clinical efficacy, condition, and pain in the 2 groups, as well as the healing timeframes for patients were measured at different stages. The findings showed that among 88 patients with pressure ulcers, 62 were infected, and the infection rate was 70.45%. The pathogens that were observed in stage II and III to IV pressure ulcers were mainly Gram-negative bacteria. The total effective rate in the combined group was 90.91%, which was much higher than that of LPPL group (70.45%). Compared with LPPL group, the pressure ulcer scale for healing and visual analogue scale scores in the combined group were markedly lower (P < .05). It is important to note that in LPPL group, the healing time of patients in stage II and stage III to IV in the combined arm were 9.76 ± 2.38 days and 13.19 ± 2.54 days, respectively. The corresponding time in the LPPL group was prolonged to 13.20 ± 3.76 and 18.82 ± 4.17 days, respectively. The main pathogens associated with wound infection in patients with pressure ulcers are Gram-negative bacteria. The curative effects of LPPL combined with sulfadiazine silver cream on patients with pressure ulcer is obviously improved, and the recovery and pain relief are faster while the healing time of pressure ulcer is shorter.

The prognostic effect of lymphocyte, monocyte, and platelet counts, mean platelet volume, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio on different stages of pressure ulcers

Background/Aim: Pressure ulcers (PU) pose a significant problem for patients in intensive care. Various factors contribute to the development of pressure sores. The primary focus of treatment is to implement measures that prevent factors such as nutrition and positioning, which can lead to PUs. Therefore, it is crucial to identify parameters that can serve as warning signals for the formation and progression of PU. This study investigates the potential use of hematological parameters as warning signals. Methods: Demographic data, co-morbidities, PU stages, and laboratory parameters of 158 patients hospitalized in the intensive care unit who developed pressure ulcers during their hospital stay were recorded and analyzed. Results: Among the 158 cases included in the study, PUs were more prevalent in patients of advanced age, those with pneumonia, chronic obstructive pulmonary disease (COPD), coronary diseases, and neurodegenerative diseases. Mean platelet volume (MPV) was significantly higher in PU stages 2 and 3 compared to stage 1. However, age, lymphocyte count, monocyte count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) did not exhibit significant differences among the stages of PU (P&lt;0.05). Conclusion: Advanced age, pneumonia, COPD, coronary diseases, and neurodegenerative diseases are identified as risk factors for PU. Although MPV was initially considered a potential, stimulating parameter, the evidence was insufficient. Further research is required to explore this issue. The impact of parameters other than MPV did not show any excitatory signal in this study.

Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study

To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.

Successful Healing of Two Very Large Pelvic-Perineal Chronic Fistulized Ulcers in A Patient with Congenital Myelomeningocele Treated with A Carbohydrate Polymer with Zinc Oxide: Case Report

Importance: A new successful therapeutic option for chronic complicated pressure lesions using a Carbohydrate Polymer with Zinc Oxide (CPZO®). Introduction: A 20-year-old male patient diagnosed with congenital Myelomeningocele was seen and examined in our office on December 08, 2014. When we first received the patient, he had two very large fistulized pressure ulcers stage IV in the gluteal and perianal areas. Both ulcers presented evidence of infection, with purulent fecal discharge, and extensive inflammation and destruction of surrounding tissue. Conclusions and Relevance: This case proves the therapeutic efficiency of CPZO® a new Medical Device II with pro- healing, anti-inflammatory and bactericidal properties on a young male patient with chronic complicated severe pressure ulcers.

Analysis of the prevalence and risk factors of pressure injuries in the hospitalized pediatric population: A retrospective study

BackgroundPressure injury (PI) is an essential indicator of the quality of nursing care and affects hospitalized newborns and children. However, studies on the prevalence of PI and associated risk factors in children are limited. AimsThis study aimed to analyze the prevalence of PI and risk factors affecting the development of PI in the hospitalized pediatric population. MethodsThis was a descriptive, retrospective study. Data were obtained via electronic medical records of 6350 pediatric patients admitted to a university hospital between January 2019 and April 2022. Ethics committee approval was obtained. Patient medical records and data associated with PI and medical treatment were collected through the ‘Information Form,’ ‘Braden Scale,’ ‘Braden Q Scale,’ ‘Pressure Ulcer Staging Form,’ and ‘Pediatric Nutrition Risk Score (PNRS).’ Data were analyzed using descriptive statistics, correlation analysis, Mann-Whitney U test, Kruskal Wallis test, and Multilinear Regression analysis. ResultsMore patients (66.2%) were males, and 49.2% of the children were 0–12 months old. 2368 out of 6350 pediatric patients were treated in the PICU. It was determined that a total of 143 PI occurred in 59 patients from PICU. The PI prevalence was 2.25% for all patients and 6.04% for PICU patients. Twenty-one percent of the patients had medical device-related PI (MDRPIs), 35.7% of PI occurred in the occiput, 13.3% in the coccyx/sacrum, and 67.1% of PI was Deep Tissue Injury. In the multiple regression model, children's albumin level, hemoglobin level, PNRS scores, Body Mass Index, and length of hospital stay significantly affected BRADEN scores. They were explained 30.3% of their scores of Braden. ConclusionDespite the limitations of the retrospective study, the prevalence of PI in the pediatric population in this study was lower than that reported in previous studies, but the prevalence of MDRPIs was higher. Based on the study results, it is recommended to implement preventive interventions for MDRPIs and plan prospective studies.

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.

Nurses' Knowledge Concerning Prevention and Treatment of Pressure Ulcers.

Pressure ulcers have high prevalence in patients and can be prevented with proper nursing interventions. The aim of this study was to evaluate nurses' knowledge about prevention and treatment of pressure ulcers. The present study was conducted with 111 nurses working in a General hospital in Greece. In this study, nurses had adequate knowledge about prevention and treatment of pressure ulcers. Respondents answered correctly in questions about staging of pressure ulcers (98.2%, 98.2%, 99.1%, 97.3%, 93.7%), the role of changing position in prevention of pressure ulcer (97.3%), the use of foam mattress (85.6%) and stretched sheets (92.8%), the use of antiseptic solution (95.5%, 85.6%), and interventions to reduce pressure on patients' heels (88.3%). A number of participants had adequate level of knowledge in the questions about the role of diet in healing of pressure ulcers (71.2%), products or devices for prevention or treatment of pressure ulcers (61.3%, 36.9%), healing of pressure ulcers (58.6%, 46.8%), prevention of bone pressure ulcers (31.5%), cleaning of a pressure ulcer (52.3%), and the role of low blood pressure as a risk factor for pressure ulcer (55.9%). However, the development of educational programs can help nurses to improve their knowledge about prevention and treatment of pressure ulcers.

Consistent pressure ulcer prevention practice: The effect on PU prevalence and PU stages, and impact on PU prevention-A quasi-experimental intervention study.

This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n=115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.

Effect of Baicalin on Wound Healing in a Mouse Model of Pressure Ulcers

One of the most frequent comorbidities that develop in chronically ill or immobilized patients is pressure ulcers, also known as bed sores. Despite ischemia-reperfusion (I/R)-induced skin lesion having been identified as a primary cause of pressure ulcers, wound management efforts have so far failed to significantly improve outcomes. Baicalin, or 5,6,7-trihydroxyflavone, is a type of flavonoid which has been shown to possess a variety of biological characteristics, including antioxidative and anti-inflammatory effects and protection of I/R injury. In vitro wound scratch assay was first used to assess the function of baicalin in wound healing. We established a mouse model of advanced stage pressure ulcers with repeated cycles of I/R pressure load. In this model, topically applied baicalin (100 mg/mL) induced a significant increase in the wound healing process measured by wound area. Histological examination of the pressure ulcer mouse model showed faster granulation tissue formation and re-epithelization in the baicalin-treated group. Next, baicalin downregulated pro-inflammatory cytokines (IL-6 and IL-1β), while upregulating the anti-inflammatory IL-10. Additionally, baicalin induced an increase in several growth factors (VEGF, FGF-2, PDGF-β, and CTGF), promoting the wound healing process. Our results suggest that baicalin could serve as a promising agent for the treatment of pressures ulcers.

Influence factors of poor efficacy after flap repair operation in patients with pressure ulcers

Objective: To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers. Methods: The retrospective case series study was conducted. From January 2011 to June 2021, 125 patients with stage Ⅲ and Ⅳ pressure ulcers treated in Hainan General Hospital met the inclusion criteria. There were 82 males and 43 females, aged 15-90 (57±20) years. According to the postoperative effects, the patients were divided into poor efficacy group (47 cases) and good efficacy group (78 cases). The clinical data of patients in the two groups were collected, including the age, gender, location, stage, size, and bone exposure of pressure ulcers, preoperative microorganism culture results of wound exudate sample, whether combined with osteomyelitis, diabetes, lower limb paroxysmal myospasm, and gatism or not, the number of surgical debridement combined with negative-pressure wound therapy, type of surgical flap, postoperative position, and preoperative albumin, leukocyte, C-reactive protein (CRP), and hemoglobin. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stage Ⅲ and Ⅳ pressure ulcers. Results: The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47, which was significantly higher than 3/78 in good efficacy group (χ2=33.83, P<0.01). The preoperative hemoglobin level of patients in poor efficacy group was (102±17) g/L, which was significantly lower than (113±20) g/L in good efficacy group (t=-3.24, P<0.01). The preoperative CRP level of patients was 39.1 (14.1, 91.6) mg/L in poor efficacy group, which was significantly higher than 15.3 (6.6, 42.0) mg/L in good efficacy group (Z=-3.04, P<0.01). There were no statistically significant differences in other indexes between patients in the two groups (P>0.05). Multivariate logistic regression analysis showed that age, lower limb paroxysmal myospasm, and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers (with odds ratios of 1.03, 40.69, and 0.97, 95% confidence intervals of 1.00-1.06, 9.18-180.39, and 0.95-1.00, respectively, P<0.05 or P<0.01). Conclusions: Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors, among which the age, lower limb paroxysmal myospasm, and preoperative hemoglobin level are the independent risk factors.

Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study

BackgroundCOVID-19 patients are at risk for the development of pressure injuries (PI). AimThe aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s. MethodsThe sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form. ResultsOf the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36). ConclusionsMDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.