Nursing Department, Texas Health Harris Methodist Hospital, Fort Worth 76104, USA.
J Wound Ostomy Continence Nurs. 2012 Sep-Oct;39(5):555-61. doi: 10.1097/WON.0b013e318264c2ec.
The evolution of suspected deep tissue injuries from an initial purple bruise to a significant stage III or IV pressure ulcer may be rapid, even with optimal treatment. This case series describes our experience with air-fluidized therapy (AFT) placed upon discovery of suspected deep tissue injury (sDTI) in an acute care setting.
Five patients with 10 sDTIs were placed on AFT within 12 hours of sDTI diagnosis and evaluated for an average of 9 days. Patients were included in the series if they met the height and weight range of the bed and presented with, or developed an sDTI. Standard wound care included the use of an ointment containing trypsin, Balsam of Peru, and castor oil (Vasolex; Stratus Pharmaceuticals Inc, Miami, Florida) applied directly to both intact skin and open areas comprising the sDTI. Patients were repositioned per standard hospital care. Although we were unable to prevent skin breakdown in every case, findings suggest that interventions resulted in a reduction in the magnitude of tissue loss, including prevention of stage III to IV pressure ulceration in all 5 patients. The cost of a 9-day length of stay on the AFT bed is estimated at less than $700 per patient, which is far less than the reported cost to treat a stage III/IV wound ($10,845 US per patient in 2009 dollars).
Our experience described in these cases suggests that the use of AFT may be clinical and cost-effective for prevention of progression of sDTI in critically ill patients. Additional research in this area should be encouraged.
从最初的紫色瘀伤到明显的 III 期或 IV 期压力性溃疡，疑似深部组织损伤 (sDTI) 的演变可能非常迅速，即使采用了最佳治疗方法。本病例系列描述了我们在急性护理环境中发现疑似深部组织损伤 (sDTI) 后立即采用空气流化治疗 (AFT) 的经验。
5 例患者共 10 处 sDTI 在 sDTI 诊断后 12 小时内被置于 AFT 上，并平均评估了 9 天。如果患者符合床的身高和体重范围，并出现或发展为 sDTI，则将其纳入该系列。标准伤口护理包括直接应用含有胰蛋白酶、秘鲁香脂和蓖麻油的软膏（Vasolex；Stratus Pharmaceuticals Inc，迈阿密，佛罗里达州）至完整皮肤和包括 sDTI 的开放区域。患者按标准医院护理进行翻身。尽管我们无法在每个病例中防止皮肤破裂，但发现表明干预措施导致组织损失程度减小，包括在所有 5 例患者中预防 III 期至 IV 期压疮。在 AFT 床上 9 天的住院费用估计为每位患者不到 700 美元，远低于治疗 III/IV 期伤口的报告费用（2009 年每位患者为 10845 美元）。
这些病例中描述的我们的经验表明，在重症患者中，使用 AFT 可能在预防 sDTI 进展方面具有临床和成本效益。应鼓励在该领域进行更多的研究。
