Pressure Injury in the ICU: Major Reconstructive Surgery Required

Abstract

Pressure injury (PI) has replaced the former nomenclature pressure ulcer, a change initiated by the National Pressure Ulcer Advisory Panel (NPUAP) however, substitutes such as pressure ulcers, decubitus ulcers, and bedsores will continue to be used by many. Increased knowledge and awareness of PIs has lead to a decline in their overall prevalence. A review of the most common risk factors, including two risk factor assessment tools, the Braden scale and the Cubbin & Jackson are presented. Diagnosing PIs must be a methodical, meticulous process in order to accurately document and monitor their progression and improvement. In 2016 the NPUAP revised the definitions as well as the stages of PIs incorporating the etiology and anatomical features present or absent in each stage of injury. Treatment strategies such as managing co-morbidities, nutrition optimization, and pain management are important aspects to consider in treating PIs in addition to thorough wound care cleansing and debridement. Highlighted are the various effective debridement options such as surgical sharp, mechanical, autolytic, enzymatic and larval debridement. Wound dressing alternatives, their advantages, disadvantages, indications and contraindications are all are mentioned. Concluding the chapter are pressure injury rates of healing, prognosis and surgical indications.

Prevalence, Prevention, and Wound Care of Pressure Injury in Stroke Patients in the Neurology Ward

“…Wound care performed on patients using sterile technique, the wound looked clean, red and no pus or exudate and no undermining. It is explained that cleaning pressure injury aims to help ease the disposal of dirt and bacteria, water or NaCl commonly used as a cleanser for most pressure injuries (Jordan, 2017). In line with the recommendation of NPUAP & EPUAP (National Pressure Ulcer Advisory Panel & European National Pressure Ulcer Advisory Panel, 2009) that if the patient's wound has no infection and no suspected infection then the solution used to clean the wound is NaCl.…”