García-Molina Pablo, Balaguer-López Evelin, Torra I Bou Joan Enric, Alvarez-Ordiales Adan, Quesada-Ramos Cristina, Verdú-Soriano José
Hospital Clínico Universitario de Valencia; Nurse Department, Valencia University, Spain.
Ostomy Wound Manage. 2012 Jul;58(7):32-9.
Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009-2011) study was conducted among PICU patients. The two pediatric mattresses - one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg - were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need). Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 -17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.
骨隆突与睡眠表面之间的压力，以及使用医疗设备产生的压力，使入住儿科重症监护病房（PICU）的儿童有发生压疮（PU）的风险。为评估两种儿科专用的、持续且具有反应性的低压床垫对压疮发生率的影响，对PICU患者进行了一项观察性、描述性、前瞻性、纵向（2009 - 2011年）研究。这两种儿科床垫——一种适用于体重500克至6千克的儿童，另一种适用于体重超过6千克的儿童——提供给有发生压疮风险的患者（Braden - Q评分≤16、新生儿皮肤风险评估量表[NSRAS]≤13或经护士评估有临床需求）。在2009年至2011年期间，30名有发生压疮风险（NSRAS风险：n = 14[13.2±3.03]，Braden - Q风险：n = 10[10.4±2.4]）的0至10岁儿童（13名[43.3%]女孩和17名[56.7%]男孩）被置于研究床垫上，中位时间为4天（范围1至25天）。入住PICU的主要原因包括呼吸系统疾病（40%）、感染性和寄生虫病（23.3%）以及肌肉骨骼系统和结缔组织疾病（10%）。作为标准护理方案一部分使用的所有其他压疮预防策略（如重新定位、特殊设备）也都得以实施。在30名参与者中，只有1名（3.3%）（95%置信区间[CI]=0.08 - 17.2%）发生了与设备无关的压疮。未发生不良事件。在使用这些特殊表面之前，2008年在同一PICU进行的一项发生率研究发现，与设备无关的压疮累积发生率为20%。在置于这些床垫上的该高危人群中观察到的与非医疗设备相关的压疮发生率令人鼓舞，值得未来进一步研究。
