The significance of pressure injuries and purpura in COVID-19 patients hospitalized at a large urban academic medical center: A retrospective cohort study

Rrapi, Renajd; Chand, Sidharth; Lo, Jennifer A.; Gabel, Colleen K.; Song, Sarah; Holcomb, Zachary E.; Moore, Kevin; Shi, Connie R.; Song, Hannah; Xia, Fan; Yanes, Daniel; Gandhi, Rajesh T.; Triant, Virginia A.; Kroshinsky, Daniela

doi:10.1016/j.jaad.2021.03.051

Cited by 11 publications

(10 citation statements)

References 5 publications

(16 reference statements)

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“…8 Nevertheless, the pathophysiology of PI lesions is complex and combines ischemia, reperfusion injury, and inflammation and the time between detection of skin damage by visual assessment or alternative techniques and development of a pressure injury varies. [9][10][11] In this study, we observed detection indicators for BE and early PI in an animal model. These indicators we measured were erythema, hardness, temperature, SEM, and UV reflectance.…”

Section: Introductionmentioning

confidence: 81%

Fluctuations in Detection Indicators and Their Significance for the Diagnosis of Early Pressure Injury in Rat Models

Hou,

Chen,

Takashi

et al. 2024

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The aim of this study was to identify the most meaningful diagnostic indicator for distinguishing blanchable erythema (BE) and stage 1 pressure injury (early PI) in an in vivo (rat) model. DESIGN: A prospective case-control design was used to complete a horizontal and vertical comparison of detection indicators during the process of fading of BE or the deterioration of early PI into ulcer in rat models. MATERIALS AND SETTING: The sample comprised 5 hairless rats with 20 injuries, of which 10 were BE and the other 10 were early PI. Data were collected at Nagano College of Nursing in 2020 in Nagano, Japan. METHODS: The BE and PI rat models were established by subjecting the dorsal skin of a hairless rat to compression between 2 neodymium magnets for 45 minutes and 3.45 hours, respectively. The affected skin was observed based on the following: (1) photography, (2) hardness, (3) temperature, (4) moisture, and (5) spectrophotometric (a* value and ultraviolet [UV] reflectance) measurements. All measurements of BE were performed at the beginning to 60 minutes after decompression, and those for early PI were performed until 48 hours after decompression. RESULTS: Multiple BE factors, such as the degree of erythema (macroscopy and a* value), hardness, temperature, and moisture, were found to have unstable fluctuations. Only UV reflectance gradually decreased from 6 hours and decreased significantly at 48 hours after decompression (P = .001 vs 1 hour). In contrast to early PI, erythema in BE obviously faded within 10 minutes. CONCLUSIONS: Study findings indicate that a continuous decrease in UV reflectance can reflect the worsening of hemorrhage in early (stage 1) PI. In contrast, other indicators including photography, skin hardness, temperature, and moisture fluctuated and did not prove predictive for PI progression. The obvious fading of erythema in BE a short time after decompression can be used for clinical observations.

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Section: Introductionmentioning

confidence: 81%

Fluctuations in Detection Indicators and Their Significance for the Diagnosis of Early Pressure Injury in Rat Models

Hou,

Chen,

Takashi

et al. 2024

Journal of Wound, Ostomy &Amp; Continence Nursing

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“…In the event of PU-related complications, early treatment can contribute to full skin recovery. 21 , 65 Neurological symptoms (mainly peripheral nerve lesions) are identified in 17 of the included studies. Thus, peripheral nerve injury appears to be a relevant disabling complication of PP.…”

Section: Discussionmentioning

confidence: 99%

Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Elmer¹,

Reißhauer²,

Brehm³

et al. 2023

Eur J Phys Rehabil Med

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INTRODUCTION Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions ( i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.

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“…Sianes-Gallén et al observed that among 1987 COVID-19 patients, 136 patients (6.8%) developed dependency-related injuries (pressure injuries, moisture-related injuries, friction-related injuries, and skin tears), with 99 of them (73%) being pressure injuries ( 16 ). Rrapi et al identified prolonged lengths of stay and high rates of endotracheal intubation as risk factors of pressure injury development in COVID-19 patients ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Pressure injury prevalence and characteristics in patients with COVID-19 admitted to acute inpatient rehabilitation unit

Bloom

Rathgeber

et al. 2023

Front. Rehabil. Sci.

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ObjectiveTo investigate the incidence and severity of pressure injuries among COVID-19 patients who required acute hospitalization and subsequent acute inpatient rehabilitation (AIR).DesignData was collected retrospectively from medical charts of COVID-19 patients who were admitted to AIR during April 2020–April 2021.SettingAcute Inpatient Rehabilitation at a single hospital in the greater New York metropolitan area.ParticipantsSubjects included COVID-19 patients (N = 120) who required acute hospitalization and subsequent acute inpatient rehabilitation, of whom 39 (32.5%) had pressure injuries.InterventionsNot applicable.Main outcome measure(s)The incidence, location, and severity of pressure injuries in COVID-19 patients, as well as demographic and clinical characteristics of the acute hospitalization.ResultsAmong patients who developed pressure injuries, more patients received mechanical ventilation (59% vs. 33%, P < 0.05) and tracheostomy (67% vs. 17%, P < 0.00001). The lengths of stay were longer in both the intensive care unit (ICU) (34 vs. 15 days, P < 0.005), and in acute inpatient rehabilitation (22 vs. 17 days P < 0.05).ConclusionPressure injuries were more common in COVID-19 patients who had longer lengths of stay, received mechanical ventilation or tracheostomy, during acute hospitalization. This supports the use of protocols to prioritize pressure offloading in this patient population.

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The significance of pressure injuries and purpura in COVID-19 patients hospitalized at a large urban academic medical center: A retrospective cohort study

Cited by 11 publications

References 5 publications

Fluctuations in Detection Indicators and Their Significance for the Diagnosis of Early Pressure Injury in Rat Models

Fluctuations in Detection Indicators and Their Significance for the Diagnosis of Early Pressure Injury in Rat Models

Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Pressure injury prevalence and characteristics in patients with COVID-19 admitted to acute inpatient rehabilitation unit

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