Pressure Ulcer Development Research Articles

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 Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes.

Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).

Impact of educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention: A pilot study

Background: Professional nurses are saddled with a unique role in patient's skincare among hospitalized patients. Inadequate nurses’ knowledge of pressure ulcer risk assessment (PURA) and prevention as a major contributory factor to development of pressure ulcer among “at risk” patients has been identified by previous studies. Aim: To evaluate the impact of an educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention at a tertiary hospital, Ibadan, Nigeria. Methods: A pilot study with sample size of 26 nurses selected through simple random sampling technique from selected nursing units of the facility. Data collection was done through a structured questionnaire. Hypotheses were tested with inferential statistics using t-test. Results were presented in descriptive statistics and charts. Level of significance was p-value &lt;0.05. Results: Almost all participants’ knowledge mean score of PURA increased from 4.92 ±1.26 at pre-test to 14.00 ± 0.71 at post-test (p&lt;0.001). Also, knowledge mean score of pressure ulcer prevention improved among intervention group (14.00 ± 0.707) post educational intervention as compared to their counterparts in control group (11.85±1.41). Educational intervention was statistically significant with participants’ knowledge of PURA and prevention (p&lt;0.001). Conclusion: The results of this study confirmed that educational intervention was impactful positively on nurses’ knowledge regarding PURA and prevention strategies at UCH, Ibadan, Nigeria. Thus, a structured educational program on the subject matter is needed to promote quality nursing care delivery according to international best practices among Nigerian nurses.

Wearable Prophylaxis Tool for AI-Driven Identification of Early Warning Patterns of Pressure Ulcers.

As today's society ages, age-related diseases become more frequent. One very common but yet preventable disease is the development of pressure ulcers (PUs). PUs can occur if tissue is exposed to a long-lasting pressure load, e.g., lying on tissue without turning. The cure of PUs requires intensive care, especially for the elderly or people with preexisting conditions whose tissue needs longer healing times. The consequences are heavy suffering for the patient and extreme costs for the health care system. To avoid these consequences, our objective is to develop a pressure ulcer prophylaxis device. For that, we built a new sensor system able to monitor the pressure load and tissue vital signs in immediate local proximity at patient's predilection sites. In the clinical study, we found several indicators showing correlations between tissue perfusion and the risk of PU development, including strongly reduced SpO2 levels in body tissue prior to a diagnosed PU. Finally, we propose a prophylaxis system that allows for the prediction of PU developments in early stages before they become visible. This work is the first step in generating an effective system to warn patients or caregivers about developing PUs and taking appropriate preventative measures. Widespread application could reduce patient suffering and lead to substantial cost savings.

Study on an Onset Mechanism of MDRPU by Wearing Elastic Stockings: Numerical Simulation by Two-Dimensional Mechanical Model.

As compared with pressure injuries, the mechanism the development of medical device related pressure ulcers (MDRPU) is not revealed enough. According to studies on severity and frequent site of occurrence, MDRPUs are surmised to occur the surface of the skin. In this study, we assess theoretical and experimental analysis by two-dimensional mechanical model for elastic stockings (ES) wear the lower limbs with or without dug into the skin by the wrinkles and curling up of ES. The Finite Element Method (FEM) was used to calculate the stress on the skin and subcutaneous tissue, because of elucidating the mechanism of MDRPU. The FEM used a triple-layered cylindrical model simulating the skin, subcutaneous tissue, and bone. Regarding the interface pressure (compression pressure), two samples were created: the one is applying a uniform pressure of 5.3 kPa on the skin surface simulating the correct wearing of ES, and the other is applying a pressure of 16 kPa on the part of the skin on which ES dug in. The results were as follows: the internal stress on the skin and subcutaneous tissue was maximum at the site where ES dug in, producing stresses of 54 kPa, 50 kPa, and 21 kPa in the circumferential, longitudinal, and radial directions, respectively. The uniform pressure produced an internal stress of 5-9 kPa on the skin surface. Unlike the mechanism of pressure injury formation, we considered compressive strength from tensile of the circumferential and longitudinal directions, furthermore the additive radial pressure at the digging site on the skin due to the wrinkles and curling of ES, which is one of the factor to cause strong external force in the MDRPU formation. (This is secondary publication from Jpn J Phlebol 2021; 32(1): 119-126.).

Chronic Wound Management in Geriatric Patients; A Case of Home Care Services

Objective: Chronic wounds are a major health problem in the geriatric population and often lead to reduced quality of life and increased healthcare costs. To evaluate the impact of chronic diseases and nutritional status on pressure ulcer development in individuals over 65 years of age enrolled in home care services. Methods: This study was conducted between 15.12.2022 - 15.01.2023 at Giresun Training and Research Hospital. Individuals registered to the Home Care Services (HCS) and aged 65 years and over were included. Sociodemographic characteristics, medical history, Nutritional Risk Screening (NRS-2002), Visual pain scale, Braden Pressure ulcus risk scale and a scale to analyze wound staging were applied. Results: The mean age of the 76 patients included in the study was 83.64±8.11 years. 80.3% of the patients were female, 86.8% needed medical care. 52.6% received HCS for neurologic, 36.8% for cardiovascular and 7.8% for respiratory diseases. When nutritional risk status was analyzed, 40.8% had a primary assessment as a result of the preliminary assessment. According to the main assessment result, 97.4% of the patients had nutritional risk. As a result of physical examination, wounds were detected in 16% of the patients. Considering the risk of pressure ulcus development, 6.8% of the patients were at high risk, 21.6% were at medium risk and 35.1% were at low risk. The mean Braden pressure scale score was 16.86±3.03. Only one of the participants described moderate pain. Conclusion: Effective management of chronic wounds in geriatric patients requires a comprehensive and multidisciplinary approach that addresses the underlying causes, promotes wound healing, and prevents complications.

Yoğun bakımda takip edilen COVID-19 hastalarında bası yarası gelişimi ve risk faktörlerinin değerlendirilmesi

Aims: In this study it was aimed to evaluate the causes of pressure ulcer development in COVID-19 patients followed in the intensive care unit (ICU).&#x0D; Methods: Demographic data, comorbidities, laboratory parameters, treatment modalities and mortality rates of the patients were reviewed retrospectively from hospital records. In addition, Acute Physiology and Chronic Health Assessment (APACHE II), Sequential Organ Failure Assessment (SOFA), and modified NUTRIC scores were calculated. Braden scale was used for pressure ulcer evaluation.&#x0D; Results: Eighty COVID-19 patients were included in the study. Pressure ulcers (PU) were detected in 29 (36.25%) of the cases, and no pressure ulcer was detected in 51 (63.75%) cases. 54 (69.7%) of the patients were male, 26 (32.5%) were female, and the mean age was 69 (61-77). The cases were divided into two groups according to the development of pressure ulcers. The APACHE II score was 24 (17-29) in the PU group and 18 (12-23) in the non-PU group (p=0.01), the mNUTRIC score was 4 (3-5) in the PU group and 3 (2-4) in the non-PU group.) (p=0.023), the Braden scale calculated at admission to the ICU was 11(10-13) in the PU group and 14(12-15) (p

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.

A pragmatic, open-label, multi-center, randomized controlled clinical trial on the rotational use of interfaces vs standard of care in patients treated with noninvasive positive pressure ventilation for acute hypercapnic respiratory failure: the ROTAtional-USE of interface STUDY (ROTA-USE STUDY)

BackgroundIn the last decades, noninvasive ventilation (NIV) has been increasingly used to support patients with hypercapnic and hypoxemic acute respiratory failure. Pressure ulcers are a frequently observed NIV-related adverse effect, directly related to interface type and exposure time. Switching to a different interface has been proposed as a solution to improve patient comfort. However, large studies investigating the benefit of this strategy are not available. Thus, the aim of the ROTAtional-USE of interface STUDY (ROTA-USE STUDY) is to investigate whether a protocolized rotational use of interfaces during NIV is effective in reducing the incidence of pressure ulcers.MethodsThe ROTA-USE STUDY is a pragmatic, parallel arm, open-label, multicenter, spontaneous, non-profit, randomized controlled trial requiring non-significant risk medical devices, with the aim to determine whether a rotational strategy of NIV interfaces is associated with a lower incidence of pressure ulcers compared to the standard of care. In the intervention group, NIV mask will be randomly chosen and rotated every 6 h. In the control group, mask will be chosen according to the standard of care of the participating centers and changed in case of discomfort or in the presence of new pressure sores. In both groups, the skin underneath the mask will be inspected every 12 h for any possible damage by blinded assessors. The primary outcome is the proportion of patients developing new pressure sores at 36 h from randomization. The secondary outcomes are (i) onset of pressure sores measured at different time points, i.e., 12, 24, 36, 48, 60, 72, 84, and 96 h; (ii) number and stage of pressure sores and comfort measured at 12, 24, 36, 48, 60, 72, 84, and 96 h; and (iii) the economic impact of the protocolized rotational use of interfaces. A sample size of 239 subjects per group (intervention and control) is estimated to detect a 10% absolute difference in the proportion of patients developing pressure sores at 36 h.DiscussionThe development of pressure ulcers is a common side effect of NIV that negatively affects the patients’ comfort and tolerance, often leading to NIV failure and adverse outcomes. The ROTA-USE STUDY will determine whether a protocolized rotational approach can reduce the incidence, number, and severity of pressure ulcers in NIV-treated patients.Trial registrationClinicalTrials.gov NCT05513508. Registered on August 24, 2022.

Pharmacotherapeutic Management of Pressure Wound in Sushma Koirala Memorial Hospital

Background: Pressure ulcers are the serious kinds of wounds that get developed within the skin tissues. They affect larger surface areas of the body resulting severe pain in the infected body parts of the patients. Pressure wound, thus has been presented as one of the major health problem worldwide. This study was aimed to find out different aspects of pressure ulcer cases and outcomes in Sushma Koirala Memorial Hospital (SKMH). Along with this, the study was targeted to study major affected body part, role of diet in healing wounds, grades of pressure ulcers and medicines used during the management and treatment of such chronic wounds.&#x0D; Methods: A descriptive, unicentric, retrospective study was conducted in 2018 at Sushma Koirala Memorial Hospital. A total of 163 patient records from October 2016 to October 2018 were reviewed. The data was entered in SPSS 16 version for analysis.&#x0D; Results: Pressure ulcers were common among people from the age group 21-40 years. The males were more vulnerable than female. Most people stayed for 41-60 days while the most affected body part in many patients was the sacral region. Third grade sacral region pressure wound was mostly found in the admitted patients. Wounds and injuries were common cause for development of pressure ulcers. The usage of third generation cephalosporin- ceftriaxone was predominantly found during surgery as well as post-surgery. During surgery, most commonly used medications include fentanyl, paracetamol, midazolam and propofol. After surgery, analgesics like ketorolac, combination of ibuprofen and paracetamol were frequently used. For post-surgical condition, ceftriaxone, ascorbic acid, ranitidine and pantoprazole were mostly used. Patients with pressure ulcers were advised to take high protein diet.&#x0D; Conclusion: This study showed sacral region was most affected body part and grade 3 pressure wound were predominant in most of the admitted patients. Ceftriaxone was mostly prescribed antibiotics and combination of paracetamol and ibuprofen was mostly prescribed for analgesic effects.

The association between acupuncture therapy and the risk of reduced pressure ulcers in dementia patients: A retrospective matched cohort study

BackgroundThe pressure ulcer is a complication developed from dementia. The aim of this study is to study the association between the development of pressure ulcers and the use of acupuncture therapy in patients with dementia. MethodsWe performed a retrospective 1:1 propensity score-matched cohort study to investigate the association between acupuncture therapy and the risk of pressure ulcers in patients with dementia. ResultsA total of 8,994 patients were identified, 237 patients in the acupuncture cohort and 362 patients in the no-acupuncture cohort developed pressure ulcers. A reduced cumulative incidence of pressure ulcers was observed in the acupuncture cohort (P<0.001). The association between acupuncture and reducing the incidence of pressure ulcers was not affected by sex, age, residence, income, or comorbidities. The variables of etiologies to cause dementia did not change the final result. In the subgroups analyses, the patients without medication for dementia control had a significantly lower rate of pressure ulcers development when they had accepted acupuncture therapy (log-rank test, P<0.001). ConclusionOur results revealed the association between acupuncture therapy and a reduced incidence of pressure ulcer development in patients with dementia. This finding offers important ideas for further research.

Optimization of Spatial and Temporal Configuration of a Pressure Sensing Array to Predict Posture and Mobility in Lying.

Commercial pressure monitoring systems have been developed to assess conditions at the interface between mattress/cushions of individuals at risk of developing pressure ulcers. Recently, they have been used as a surrogate for prolonged posture and mobility monitoring. However, these systems typically consist of high-resolution sensing arrays, sampling data at more than 1 Hz. This inevitably results in large volumes of data, much of which may be redundant. Our study aimed at evaluating the optimal number of sensors and acquisition frequency that accurately predict posture and mobility during lying. A continuous pressure monitor (ForeSitePT, Xsensor, Calgary, Canada), with 5664 sensors sampling at 1 Hz, was used to assess the interface pressures of healthy volunteers who performed lying postures on two different mattresses (foam and air designs). These data were down sampled in the spatial and temporal domains. For each configuration, pressure parameters were estimated and the area under the Receiver Operating Characteristic curve (AUC) was used to determine their ability in discriminating postural change events. Convolutional Neural Network (CNN) was employed to predict static postures. There was a non-linear decline in AUC values for both spatial and temporal down sampling. Results showed a reduction of the AUC for acquisition frequencies lower than 0.3 Hz. For some parameters, e.g., pressure gradient, the lower the sensors number the higher the AUC. Posture prediction showed a similar accuracy of 63-71% and 84-87% when compared to the commercial configuration, on the foam and air mattress, respectively. This study revealed that accurate detection of posture and mobility events can be achieved with a relatively low number of sensors and sampling frequency.

Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit

Purpose: A retrospective descriptive study was performed to develop strategies to manage or prevent pressure ulcers in patients with severe trauma being cared for in the trauma intensive care unit (TICU).Methods: Study data was compiled from 315 patients with severe trauma (injury severity score ≥ 15) who were admitted to a general hospital from January 1, 2020, to February 28, 2021 and were being cared for in the TICU. For patients with pressure ulcers, the characteristics and associated factors of pressure ulcers were examined.Results: There were 42 severe trauma patients (13.3%) with pressure ulcers, of which, 50.0% of cases occurred at the site of the coccyx. In 50% of patients, Stage 2 pressure ulcers were observed. The mean onset day of pressure ulcers was 9.74 days after admission. The occurrence of diabetes, critical care triage score, length of stay in intensive care, death, shock, dialysis, ventilator application, endotracheal intubation, peripheral insertion central catheter insertion, A-line insertion, body protector application, sedatives, blood pressure boosters, nasal cannula, high-flow oxygenators, oxygen tip application, drainage insertion, nasogastric tube nutrition, and ventilator application period were investigated. Logistic regression analysis revealed that the influencing factors for the development of pressure ulcers were endotracheal intubation, length of stay in the TICU, and age, in that order.Conclusion: By identifying the characteristics and risk factors associated with pressure ulcers in patients with severe trauma, strategies can be developed to better prevent or manage pressure ulcers in the future.

Keratinocyte-Specific SOX2 Overexpression Suppressed Pressure Ulcer Formation after Cutaneous Ischemia–Reperfusion Injury via Enhancement of Amphiregulin Production

Ischemia-reperfusion (I/R) injury is a key player in the pathogeneses of pressure ulcer formation. Our previous work demonstrated that inducing the transcription factor SOX2 promotes cutaneous wound healing through EGFR signaling pathway enhancement. However, its protective effect on cutaneous I/R injury was not well-characterized. We aimed to assess the role of SOX2 in cutaneous I/R injury and the tissue-protective effect of SOX2 induction in keratinocytes (KCs) in cutaneous I/R injury. SOX2 was transiently expressed in KCs after cutaneous I/R injury. Ulcer formation was significantly suppressed in KC-specific SOX2-overexpressing mice. SOX2 in skin KCs significantly suppressed the infiltrating inflammatory cells, apoptotic cells, vascular damage, and hypoxic areas in cutaneous I/R injury. Oxidative stress-induced mRNA levels of inflammatory cytokine expression were suppressed, and antioxidant stress factors and amphiregulin were elevated by SOX2 induction in skin KCs. Recombinant amphiregulin administration suppressed pressure ulcer development after cutaneous I/R injury in mice and suppressed oxidative stress-induced ROS production and apoptosis invitro. These findings support that SOX2 in KCs might regulate cutaneous I/R injury through amphiregulin production, resulting in oxidative stress suppression. Recombinant amphiregulin can be a potential therapeutic agent for cutaneous I/R injury.

Epidemiology of pressure ulcers in Le Mans General Hospital between 1996 and 2019: Impact of a dedicated "Pressure ulcer, Wounds and Healing" task force.

Pressure ulcers (PUs) are one of the most important care-related ailments, making their prevention a pressing concern for hospital structures. Epidemiology of PU is interesting to adapt human resources and observe the impact of targeted public health measures. Very few data are presented in the French literature. In this context, a dedicated "Pressure ulcer, Wounds and Healing" task force was created in 1996 by a multidisciplinary team of physicians, administrative staff, and paramedics in the CH of Le Mans. Alongside this, an annual prevalence study was performed between 1996 and 2019 in CH of Le Mans, collecting relevant data: the number of patients who presented pressure ulcers, the number of patients who were at risk of developing pressure ulcers, and the severity of these ulcers. This study brings new data about PU epidemiology in France and shows a significant decrease in the prevalence, becoming lower than the national prevalence. Also, a significant time-related regression of the prevalence was observed, the severity level continually decreased whereas the number of geriatric patients grew and patients with PU's risk remained constant. Finally, the number of patients who developed a PU within the hospitalization decreased too. We observed a link between the creation of the task force and the evolution of pressure ulcer epidemiology, thus recommending that the same practices be adopted in other hospitals and fields of application.

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.

Pressure injuries in COVID-19 patients: A tertiary center experience

Pressure ulcers continue to severely impact patient outcomes and increase health care costs. We aimed to examine the incidence and risk factors related to pressure ulcers among COVID-19 patients. A retrospective was conducted between March 2020-April 2021. Baseline differences were examined using chi-square and Fischer's exact test. Logistic regression was employed to examine the association of the collected variables to development of new pressure ulcers. 4608 patients were included, of which eighty-three acquired new pressure ulcers. Risk factors were increased age, peripheral artery disease, abnormal albumin levels, but not prone position.

Design and Testing of Pressure Ulcers Preventive Bed for Neonates in Neonatal Intensive Care Units

In neonatal intensive care units (NICUs), preterm infants lie down immobile for long hours in a particular position, which makes them susceptible to develop pressure ulcers (PUs). These are developed due to continuous constant contact pressure generated by the self-weight of the infants with bed surfaces on their sensitive skin, which is 60% less than the thickness of an adult and hampers blood flow from the subcutaneous areas. Therefore, it is necessary to change the posture in a periodic manner. Hospitals manage the position changes by nursing staff, which is of limited effect and puts additional loads on them. Hence, in this paper, an anti-pressure ulcer bed was designed and tested to prevent pressure ulcers and also help in reducing the effort of nurses. The contact pressure of both the neonatal phantom and neonatal baby with the silicone-made bed surface was automatically varied by fluid pressure in the multi-channels based on the actuation mechanism (which rises alternately in inflated regions and falls in deflated regions), and it was measured using the force sensors. The demonstrated work was carried out in finite element modeling (FEM) using Abaqus to validate the results. We anticipate that itll reduce the risk of pressure ulcers, confirming the designed beds performance.

Severe Pressure Ulcers in Two Patients With Adrenoleukodystrophy

Adrenoleukodystrophy (ALD) is a rare X-linked disease that affects the metabolism of very long-chain fatty acids (VLCFAs), leading to cognitive deterioration, progressive spastic paraplegia, sensory disturbance, adrenocortical insufficiency, and bladder and bowel abnormalities. Although the symptoms of ALD correspond to the risk of developing pressure ulcers, a pressure ulcer has never been listed as a complication of ALD. We present two cases of ALD with severe pressure ulcers in the pelvic region and feet. The first case was a 27-year-old male patient with adolescent cerebral-type ALD who had pressure ulcers with bone exposure on the sacral and bilateral greater trochanter region. The second case was a 64-year-old male patient with adrenomyeloneuropathy (AMN) phenotype who had pressure ulcers on the sacral region and both feet. Both patients had VLCFA accumulation and a likely pathogenic variant in the ABCD1 gene, the causative gene of ALD. These cases indicate that ALD patients with immobility and incontinence have a higher risk of developing severe pressure ulcers, which requires the proactive identification of ALD patients and early multidisciplinary intervention for patients and their families to prevent the development of pressure ulcers.

Pressure ulcers in critically ill: correlation with Intensive Care conditions

Introduction: Critically ill are a special category of patients in need of high standards medical and nursing care. Multiple intrinsic and extrinsic factors that characterize these patients tend to contribute into the development of pressure ulcers. Despite the fact that the implementation of preventive measures seems to inhibit the development of pressure ulcers in a significant percentage, there are often conditions that cannot be surpassed and result to the appearance of unavoidable pressure ulcers. Aim: Study of the factors that contribute to the development of pressure ulcers for the critically ill and the effectiveness of the preventive measures applied in ICU. Method: Information regarding hospitalization data was obtained for all 351 critically ill admitted in an ICU of a regional university hospital during a one year period (May 2021-April 2022). Subsequently, a statistical analysis was performed in order to relate the development of pressure ulcers and intrinsic factors as well as other factors such as medication administered, feeding and preventive measures applied. Results: Incidence of decubitus ulcers was estimated at 23%, first noticed on the 10th day from admission, located in the coccyx at a rate above 50%. Extrinsic factors that seem to contribute to the development of pressure ulcers appear to be the length of ICU stay, the administration of vasoactive drugs and the insufficient caloric and protein coverage through feeding. Use of preventive surfaces, seem to act as a deterrent for pressure ulcer development for the majority of the patients. Most of the pressure ulcers developed during ICU stay, were evaluated as stable or improved during ICU discharge. Conclusions: Improvement of the parameters involved in pressure ulcer development for the critically ill, contribute to the reduction of their occurrence in ICU. Despite the use of advanced pressure reducing surfaces, tissue ischemia may occur even after mild pressure applied. However, high percentage of pressure ulcers could be prevented with appropriate medical care.