Pressure injury prediction models for critically-ill patients should consider both the case-mix and local factors

Deschepper, Mieke; Labeau, Sonia; Waegeman, Willem; Blot, Stijn; Team, DecubICUs study

doi:10.1016/j.iccn.2021.103033

Cited by 16 publications

(8 citation statements)

References 4 publications

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“…Even though Braden Scale covers seven domains to determine the skin condition, it does not include other specific risk factors of PIs in ICU patients such as age, sedation, vasoactive agents, and mechanical ventilation. In any case, the observation that the Braden Scale was not associated with ICU‐acquired PI risk, while it was in the bigger study, supports the hypothesis by Deschepper et al 30 that case‐mix and contextual factors are more detrimental in assessing PI risk compared with the more generic Braden Scale. Future research may be needed to explore other reliable PI prediction tools for ICU patients.…”

Section: Discussionsupporting

confidence: 85%

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Lin

et al. 2021

International Wound Journal

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Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi‐centre, one‐day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU‐acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU‐acquired pressure injuries were at stage I, one‐fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air‐filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU‐acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.

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Section: Discussionsupporting

confidence: 85%

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Lin

et al. 2021

International Wound Journal

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“…Altogether, these findings are really important, helping nurses and physicians to better identify patients who require additional care. For instance, the widely used Braden scale to assess the risk for pressure ulcers (which takes into account sensory perception, skin moisture, activity, mobility, nutrition, friction and shear) has poor predictive value for patients in ICU ( Cox, 2012 , Deschepper et al, 2021 , Zhang et al, 2021 ). For this reason, in addition to standard tools, BMI should be considered when evaluating the risk for pressure ulcers development.…”

Section: Discussionmentioning

confidence: 99%

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Binda¹,

Galazzi²,

Marelli³

et al. 2021

Intensive and Critical Care Nursing

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Objective To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. Methods Cross-sectional study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if none unplanned extubation was recorded. Bleeding of upper airways represented the most common site (17.5%). Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04 to 3.6). Conclusion The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.

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“…As the causes for admission to the medical ICU mainly were sepsis, shock, or respiratory failure, the patients’ baseline characteristics were different from those admitted to the surgical or neurosurgical ICUs or from neurologic patients. Deschepper et al [ 2 , 35 ] demonstrated that the typical heterogeneity of an ICU population impedes the development of a universal prediction scale, and the same investigators demonstrated in another study the potential risk factors for pressure injury acquisition differ significantly depending on the type of ICU admission, either medical, surgical-elective, or surgical-emergency. Therefore, the prevalence and risk factors for pressure injuries can be different in other ICUs.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit

Lee

Hong

et al. 2022

Korean J Intern Med

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Background/Aims: Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU. Methods: We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics. Results: We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011). Conclusions:The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, "friction and shear" was associated with the development of pressure injuries in ICU patients.

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Pressure injury prediction models for critically-ill patients should consider both the case-mix and local factors

Cited by 16 publications

References 4 publications

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Complications of prone positioning in patients with COVID-19: A cross-sectional study

Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit

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