Skin Integrity in Critically Ill and Injured Children

Abstract

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.

Prevention of pressure ulcers after pediatric tracheotomy using a Mepilex Ag dressing

“…Pressure ulcers are associated with prolonged hospital stay and increased risk of secondary infection . The financial burden associated with hospital‐acquired pressure ulcers is also not insignificant, with an estimated treatment cost of $11 billion every year . In 2008 the Centers for Medicare & Medicaid Services (CMS) suggested that hospital‐acquired pressure ulcers should be minimized, which may also affect Medicare and Medicaid reimbursement .…”

Device-related pressure ulcers: SECURE prevention

“…17 Mechanical ventilation and a respiratory diagnosis are associated with higher risk of DRPU in this population. 18 In newborns, devices may severely a ect and distort nasal cartilage. e incidence of PU in paediatric patients may be as high as 28%, with non-invasive mechanical ventilation associated with PU formation (relative risk ratio 12.24).…”

Tradução para a língua portuguesa e validação da escala de Braden Q para avaliar o risco de úlcera por pressão em crianças

“…Among the various studies of PU epidemiology (2,(15)(16)(17)(18)(19) . Baldwin found an incidence rate of 0.29% in a nationwide U.S. study of hospitalized or non-hospitalized children (2) .…”

“…The more immature the child and the more critical its condition, the less tolerant the skin and underlying structures and, consequently, the higher the risk of pressure sores (14,15) . Studies conducted in the U.S. pediatric population have revealed a prevalence of PUs ranging from 0.47% to 17% (4,(16)(17)(18) .…”