Ulcer pressure prevention and opportunity for innovation during the COVID-19 crisis

Nani, Fernando Souza; Stéfani, Kelly Cristina; Busnardo, Fábio de Freitas; Monteiro, Gustavo Gomes Ribeiro; Santos, Maria Gabriela Guimarães Ribeiro dos; John, Vanderley M.; Gouvêa, Douglas; Carmona, Maria José Carvalho

doi:10.6061/clinics/2020/e2292

Cited by 6 publications

(6 citation statements)

References 9 publications

(7 reference statements)

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“…MIA/US protocol was described previously [ 24 ] and was adapted for COVID-19 for safety reasons [ 21 , 22 ]. An expert in US performed the scanning and analysis on all patients, as well as tissue collection (RAAM).…”

Section: Methodsmentioning

confidence: 99%

“…We established an autopsy protocol to produce information for the ICU team and to carry out mechanistic studies on the pathogenesis of COVID-19. As we do not have autopsy facilities with level 3 protection, we use an ultrasound-guided minimally invasive autopsy protocol (MIA/US) to perform post mortem examinations [ 21 , 22 ]. Post-mortem ultrasonography was used to locate the organs of interest and to identify the intra-organ heterogeneity of disease, guiding tissue collection.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings

et al. 2021

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This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19. Methods:We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches.Results: Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD. Conclusion:The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings

et al. 2021

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“…In resource-limited critical care settings, severe respiratory disorders and multi-organ dysfunctions associated with emerging pathogens like Severe acute respiratory syndrome (SARS-CoV), avian influenza A (H5N1), the 2009 influenza A (H1N1) pandemic, Middle East respiratory syndrome coronavirus (MERS-CoV), and avian influenza A (H7N9), increase the concomitant risk factors for PI/PU incidence [10,15]. The pathophysiological congruity between severe respiratory disorders, etiology, PIs due to prolonged prone positioning and medical device-related PIs is evident [10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning

Bryant

Moore

Iyer

2021

Expert Review of Medical Devices

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Introduction: Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need. Areas covered: This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice. Expert opinion: The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).

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“…There was no greater number of ulcer debridement procedures in the last year, despite the increase in ICU admission rates, worldwide and in Brazil, due to the COVID-19 epidemic [2,17]. Some studies have even demonstrated a higher incidence of pressure ulcers in patients with COVID-19 compared to patients without COVID-19 [1] In fact, it was noticed in this excerpt of the study, a trend towards a decrease in the number of hospitalizations with surgical debridement of ulcers/devitalized tissues.…”

Section: Discussionmentioning

confidence: 99%

“…After the onset of the COVID-19 pandemic, there was an increase in patients in critical states in the units in the city of São Paulo, demanding the creation of new ICU beds and increased use of the prone position [2][3][4]. It is estimated that 31.1% of patients hospitalized in critical units for COVID developed pressure ulcers requiring daily follow-up, increased hospital costs and increased risk of mortality [5,6].…”

Section: Introductionmentioning

confidence: 99%

Incidence of intra-hospital care related to pressure ulcers and the influence of the COVID-19 pandemic in the city of São Paulo, from March to December 2020

M¹,

Goldenberg²,

Ferreira³

et al. 2022

Int Arch Med

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In Brazil, there is no published article that measures the expense of this condition for the health system. There are international studies that show that treating a pressure ulcer is significantly more expensive than preventing it. The purpose of this article is to describe the incidence of patients with hospitalization related to pressure ulcers, in the city of São Paulo, in the period of the 1st increase in cases of COVID - 19 (March 2020 to December 2020), as well as the related expense with these hospitalizations.

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Ulcer pressure prevention and opportunity for innovation during the COVID-19 crisis

Cited by 6 publications

References 9 publications

Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings

Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings

Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning

Incidence of intra-hospital care related to pressure ulcers and the influence of the COVID-19 pandemic in the city of São Paulo, from March to December 2020

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