Release of sodium pyruvate from sacral prophylactic dressings: A computational model

Abstract

The use of sacral dressings for pressure ulcer prevention is growing rapidly. In addition to their passive biomechanical role in pressure and shear reduction, in the near future, prophylactic dressings may also provide active tissue protection by releasing preventive agents or drugs into skin and deeper tissues. We investigated delivery of sodium pyruvate (NaPy) from an active dressing to potentially protect the sacral skin and underlying tissues in addition. We used four finite element model variants describing different skin roughness levels to determine time profiles of NaPy diffusion from the dressing into the skin layers. The NaPy concentrations for the different modelled cases stabilised after 1 to 6.5 hours from the time of application of the dressings, at 1% to 3% of the NaPy concentration in the dressing reservoir, which is considered potent. We conclude that prophylactic sacral dressings have the potential to deliver NaPy into skin and subdermally, to potentially increase soft tissue tolerance to sustained bodyweight-caused cell and tissue deformations. The time durations to achieve the steady-state potent NaPy dermal concentrations are clinically feasible, for example, for preparation of patients for surgery or for use in intensive care units. K E Y W O R D Ssodium pyruvate, pressure ulcer prevention, prophylactic dressings, computational simulations

Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries

“…An example of an extrinsic confounding factor that has been shown to have a profound effect on the tissue tolerance to pressure damage is temperature, which is important in aspects of interaction with support surfaces and medical devices 50‐52 . Another intrinsic confounding factor may be arteriolar insufficiency and endothelial dysfunction, for example, related to diabetes mellitus 53,54 …”

“…The described recent advances in research also enable various innovative approaches for primary and secondary PU/PI prevention 53,101,143‐147 . These innovations are promising and urgently needed because the incidence and prevalence of PUs/PIs remain high across all healthcare settings 1 .…”

“…[50][51][52] Another intrinsic confounding factor may be arteriolar insufficiency and endothelial dysfunction, for example, related to diabetes mellitus. 53,54 Minimising pressure and shear stresses at the interface between the body and a support surface or at a skindevice contact region are effective clinical interventions for reducing the risk of developing PUs/PIs. 1,[55][56][57] However, pressure measurements alone are not reliable measures for the risk of tissue breakdown, given that similar interface pressure magnitudes will translate to considerably different internal tissue loads in different individuals depending on their internal anatomy (curvature of bony prominences, masses and composition of soft tissues, skin roughness characteristics, and soft tissue mechanic properties).…”

“…1 The described recent advances in research also enable various innovative approaches for primary and secondary PU/PI prevention. 53,101,[143][144][145][146][147] These innovations are promising and urgently needed because the incidence and prevalence of PUs/PIs remain high across all healthcare settings. 1 Until evidence supports clinical effectiveness of these innovations, evidence-based PU/PI prevention should be based on the latest guideline recommendations.…”

High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial

“…Future prophylactic dressings for use in the OR will very likely provide active protection for the length of surgery to improve on the current passive biomechanical protection mechanisms described in the Introduction section here. Novel preventative dressing technologies developed by author Gefen A. and his collaborators currently combine the release of the tissue‐protectant sodium pyruvate (NaPy) with non‐damaging low‐level strains applied to skin . The combined application of NaPy and low‐level strains shows promise in actively protecting and stimulating tissues against damaging loads occurring during the surgery by, respectively, enhancing the tolerance of cells and/or their ability to repair micro‐damage.…”