Assessment of risk for pressure ulcers in intensive care units: an integrative review

Abstract

Alves AGP, Borges JWP, Brito MA. Objective: To analyze in the scientific production the use of risk assessment scales for Pressure Ulcer (UPP) in the Intensive Care Unit. Method: There was conducted an integrative review the databases LILACS, MEDLINE and SciELO, with selection of 18 articles. Results: It was discovered that several risk factors, such as: the difference in the prevalence of UPP in relation to gender, body mass index and the difficulty in mobility in bed, altered sensory perception compromising the verbalization of discomfort, and the use of the Urinary Catheter preventing the appearance of the lesions. The scores of the scales remained at high risk and the use of the Glasgow coma scale helped in preventing the risk associated with the UPP when associated to the Bradem. Conclusion: It is needed new studies evaluating the risks of UPP, so it can be possible to provide knowledge, which can modify this reality. Descriptors: Scales, Pressure ulcer, Nursing.Objetivo: Analisar na produção científica a utilização de escalas de avaliação de risco para Úlcera por Pressão (UPP) em Unidade de Terapia Intensiva. Método: Realizou-se uma revisão integrativa nas bases de dados LILACS, MEDLINE e SciELO, com seleção de 18 artigos. Resultados: Constataram-se vários fatores de risco, tais como: a divergência na predominância da UPP em relação aos sexos, o índice de massa corporal e a dificuldade de mobilidade no leito, a percepção sensorial alterada comprometendo a verbalização de desconforto, e o uso da Sonda Vesical de Demora prevendo o surgimento das lesões. As pontuações das escalas mantiveram-se em risco elevado e a utilização da escala de coma de Glasgow ajudou na prevenção do risco para UPP quando associada à de Bradem. Conclusão: são necessárias novas pesquisas que avaliem os riscos para UPP, bem a fim de proporcionar conhecimento que possa modificar essa realidade. Descritores: Escalas, Úlcera por pressão, Enfermagem.Objetivo: Analizar en la producción científica el uso de las escalas de evaluación de riesgos para Úlceras por Presión (UPP) en la Unidad de Cuidados Intensivos. Método: Se realizó una revisión integradora en las bases de datos LILACS, MEDLINE y SciELO, con la selección de 18 artículos. Resultados: Se ha descubierto que varios factores de riesgo, en las que destacó: la divergencia en la prevalencia de UPP en relación con el sexo, el índice de masa corporal y la dificultad de la movilidad en la cama, la percepción sensorial alterada comprometiendo la verbalización de incomodidad, y el uso de la catéter urinario para prevenir la aparición de las lesiones. Las puntuaciones de las escalas se mantuvo en alto riesgo y el uso de la escala de coma de Glasgow ayudó en la prevención de los riesgos para la UPP cuando asociada a la de Bradem. Conclusión: Se necesitan más estudios que evalúen los riesgos para la UPP, así como para proporcionar el conocimiento que pueda cambiar esta realidad. Descriptores: Escalas, Úlceras por Presión (UPP), Enfermería.

Association between pressure injury prediction and biochemical markers

“…The high prediction for the incidence of pressure injury evidenced in this study was also obtained in a recent systematic review studies that applied the Braden Scale in an intensive care unit (13) , which is consistent with the risk of incidence of pressure injuries in that sector. This probably comes from the fact that, in clinical practice, it is known that patients in intensive care units have little or no mobility and activity, which can determine areas of tissue exposure to high pressures, vital factor to the development of adverse events in the study.…”

“…It is also noteworthy that people undergoing surgical procedures lasting longer than two hours have a high risk for developing pressure injuries. Therefore, it is reaffirmed that the patient in need of such intervention deserves preventive care in the transoperative period, which should be in the moments after to his hospitalization (13) .…”

Pressure Ulcer Risk Evaluation in Critical Patients: Clinical and Social Characteristics

“…Sex-related data were similar to another study with an incidence of 52.6% of female patients [ 18 ]. Women are at an increased risk for developing PU, which is in part due to their higher level of adipose tissue, placing increased pressure on the tissues and resulting in cell hypoxia [ 19 ].…”

Nursing interventions and outcomes for pressure ulcer risk in critically ill patients

“…According to an integrative review on pressure ulcer risk assessment, the Braden Scale serves as a predictive instrument to infer this diagnosis (10) , evaluating items such as sensory perception, nutrition, moisture, activity, friction and shear and mobility. In fact, the use of the Braden scale is highlighted as an important strategy in the prevention of pressure ulcers in critical units (5) .…”

“…Moisture is observed to behave as one of the determinants factors for pressure ulcers, a condition that makes the skin more fragile and susceptible to friction and maceration. Moisture, whether derived from products or physiological secretions and fluids, causes softening and maceration of the skin, reducing the tensile strength of the skin, making it fragile to compression, friction and shear, besides promoting the growth of microorganisms that harm its integrity (10) . Therefore, care with urinary catheter and related injuries is highly recommended, as well as closed drainage in intestinal incontinence and urinary incontinence as priority interventions to decrease or minimize the risk of pressure ulcers in critically ill patients.…”