Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Abstract

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3).

Role of microRNAs in Pressure Ulcer Immune Response, Pathogenesis, and Treatment

“…Most often seen at sites overlying bony prominences, pressure injury occurs when external forces on the skin and soft tissue ultimately result in internal damage and skin ulceration; however, the physiologic derangements leading to wound formation are complex and multifactorial [5,7]. Patient populations with decreased mobility are at particular risk of pressure injury due to prolonged mechanical force during periods of static positioning, including patients with spinal cord injury as well as patients undergoing prolonged operations [4][5][6]11].…”

“…Pressure wounds are considered a preventable disease, and the National Quality Forum identified the development of a severe pressure ulcer as a Serious Reportable Event that will not receive Centers for Medicaid and Medicare Services (CMS) reimbursement [1]. Despite this, pressure injury affects 6-18% of hospitalized patients [2,3], with significantly higher prevalence in chronically ill or bedridden individuals, such as patients in the intensive care unit or those with spinal cord injury [4][5][6]. Patients who develop pressure ulcers have significant psychosocial burden associated with the disease, including increased anxiety and feelings of social isolation, in addition to the physical morbidity associated with prolonged hospital stays and increased risk of infection [7].…”

Leaving a mark: pressure injury research in the intensive care unit

“…Patient (age, male sex, comorbidity) and treatment (mechanical ventilation) risk factors for PI observed in the DecubICUs study contribute to a clinical paradox [5]. While multicomponent prevention bundles including frequent risk assessment, repositioning, and use of pressure redistribution surfaces are believed to reduce the incidence of PIs [6], the non-modifiable nature of contributing risk factors may mean some PIs are unavoidable [7].…”

“…Labeau, Blot and the DecubICUs research team, in collaboration with the ESICM, should be lauded for elevating the profile of PIs to mainstream status in their recent publication [5]. Prior to this study, there were no rigorous, international data to explicate the burden of PIs, their associated risk factors nor their important implications for morbidity and mortality.…”

“…The DecubICUs study identified that one in four ICU patients will have a PI [5]. Uncertainties regarding the prevention of every PI underscore the importance of research in this domain (Table 1).…”