The Association of BMI and Braden Total Score on the Occurrence of Pressure Ulcers

Drake, Daniel J.; Swanson, Melvin; Baker, G. Ross; Pokorny, Marie E.; Rose, Mary Ann; Clark-Reed, Laurie; Waters, Wanda; Watkins, Frank; Engelke, Martha Keehner

doi:10.1097/won.0b013e3181e45774

Cited by 49 publications

(42 citation statements)

References 17 publications

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“…This finding is consistent with the US data from an international pressure ulcer prevalence survey in which the prevalence of pressure ulcers was higher in underweight and extremely obese patients. 6,32 The underweight and extremely obese groups did not differ in race/ethnicity, total scores on the Braden scale, incidence of pressure ulcers, length of ICU stay, or discharge disposition; however, differences in sex and mean age were significant. Compared with patients in the other groups, extremely obese patients were 4 to 5 years younger and more likely to be women.…”

Section: Discussionmentioning

confidence: 77%

“…23 In addition, obesity among patients is a main reason for injuries among care providers. 19 Extreme obesity has been associated with an increased prevalence of pressure ulcers in patients in a tertiary medical center, 6 and among elderly patients, pressure ulcers are less likely to develop in nonobese patients 24,25 and in general surgery patients. 23 In critical care, BMI has been associated with the development of pressure ulcers in patients treated with mechanical ventilation who had acute lung injury.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…4,5 Obesity contributes to immobility in the ICU and subsequent pressure on skin surfaces. 6 Helping obese patients change their position in bed to relieve sites of increased skin pressure is a challenge for caregivers. 7 …”

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confidence: 99%

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Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

Hyun¹,

Li²,

Vermillion³

et al. 2014

American Journal of Critical Care

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Background Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. Objectives To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. Methods In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients’ demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. Results The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. Conclusions Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.

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Section: Discussionmentioning

confidence: 77%

Section: Review Of the Literaturementioning

confidence: 99%

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Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

Hyun¹,

Li²,

Vermillion³

et al. 2014

American Journal of Critical Care

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“…Kottner et al indicated that the etiology and pathogenic mechanisms of the development of pressure ulcers on the trunk and heel may be different. Furthermore, in a comparison of the prevalence of pressure ulcers in patients with a BMI of 40 or more and Braden Scale scores of 16 or more with the prevalence in patients with lower BMI, Drake et al 25 found that the prevalence among patients with a BMI less than 40 was 12.5% compared to a prevalence of 26% in patients with a BMI greater than 40 ( P = .01). Patients with BMIs greater than 40 were almost 3 times more likely to have a pressure ulcer than were patients with BMIs of 40 or less, after controlling for scores on Braden Scale indicative of risk ( P = .01).…”

Section: Discussionmentioning

confidence: 99%

Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation

Grap¹,

Munro²,

Wetzel³

et al. 2016

American Journal of Critical Care

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Background Backrest elevations less than 30° are recommended to reduce pressure ulcers, but positions greater than 30° are recommended during mechanical ventilation to reduce risk for ventilator-associated pneumonia. Interface pressure may vary with level of backrest elevation and anatomical location (eg, sacrum, heels). Objective To describe backrest elevation and anatomical location and intensity of skin pressure across the body in patients receiving mechanical ventilation. Methods In a longitudinal study, patients from 3 adult intensive care units in a single institution receiving mechanical ventilation were enrolled within 24 hours of intubation from February 2010 through May 2012. Backrest elevation (by inclinometer) and pressure (by a pressure-mapping system) were measured continuously for 72 hours. Mean tissue interface pressure was determined for 7 anatomical areas: left and right scapula, left and right trochanter, sacrum, and left and right heel. Results Data on 133 patients were analyzed. For each 1° increase in backrest elevation, mean interface pressure decreased 0.09 to 0.42 mm Hg. For each unit increase in body mass index, mean trochanter pressure increased 0.22 to 0.24 mm Hg. Knee angle (lower extremity bent at the knee) and mobility were time-varying covariates in models of the relationship between backrest elevation and tissue interface pressure. Conclusions Individual factors such as patient movement and body mass index may be important elements related to risk for pressure ulcers and ventilator-associated pneumonia, and a more nuanced approach in which positioning decisions are tailored to optimize outcomes for individual patients appears warranted.

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“…Morbid obesity has been associated with longer ICU length of stay and prolonged mechanical ventilation, with increased overall mortality and ICU mortality currently under debate [7], [8]. Factors contributing to ICU mortality in extreme-obesity include increased catheter and blood stream infections [9], limited imaging modalities, increased skin breakdown [10], and diagnostic errors. Additionally, a condition called MOHS was recently described [11].…”

Section: Introductionmentioning

confidence: 99%

A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs

Tatusov

Joseph

Cuneo

2017

Respiratory Medicine Case Reports

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IntroductionThe obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS).Case presentation35 year old African American gentleman with a body mass index (BMI) of 115 kg/m2 presented to the hospital with respiratory distress. On admission he was noted to have multi-organ dysfunction including respiratory failure, renal failure, cardiac and liver abnormalities. His hospital course was remarkable for recurrent cardiac arrest following extubation, complicated tracheostomy, and progressive organ failure despite medical therapy. After a 30 day hospitalization, patient and family decided on terminal extubation owing to worsening medical condition and lack of therapeutic and disposition options.DiscussionThe super obese present a number of challenges when admitted to the ICU. Patients with respiratory distress are frequently misdiagnosed and treated for asthma and COPD when obesity hypoventilation syndrome (OHS) is more consistent with the clinical picture. OHS in the superobese is often accompanied by multi-system organ dysfunction, a condition with high morbidity and mortality, with limited treatment options. Standard imaging techniques and procedures are made difficult or impossible by body habitus and often require expert intervention. Surgical options have been used in the treatment of the super obese and resulted in rapid weight loss, improvement in respiratory function, as well as improved metabolism and decreased inflammation. The role of surgery in MOHS remains to be elucidated.ConclusionPhysicians should be aware of MOHS as a common condition with high morbidity and mortality. Optimal management remains to be determined.

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The Association of BMI and Braden Total Score on the Occurrence of Pressure Ulcers

Abstract: A BMI of more than 40 and Braden Scale score of 16 or less were found to have an independent and statistically significant association with PU occurrence. Future studies should investigate the predictive validity of BMI along with individual Braden subscales.

Cited by 49 publications

References 17 publications

Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation

A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs

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