Behrendt Robert, Ghaznavi Amir M, Mahan Meredith, Craft Susan, Siddiqui Aamir
Robert Behrendt is a clinical quality facilitator in the Office of Clinical Quality and Safety, Henry Ford Health System, Detroit, Michigan. Amir M. Ghaznavi is a plastic surgery fellow and Aamir Siddiqui is a professor of surgery in the Division of Plastic and Reconstructive Surgery, Henry Ford Hospital, Detroit, Michigan. Meredith Mahan is a biostatistician in the Department of Public Health Sciences, Henry Ford Health System. Susan Craft is a staff nurse unit director in the medical intensive care unit at Henry Ford Hospital.
Am J Crit Care. 2014 Mar;23(2):127-33. doi: 10.4037/ajcc2014192.
Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient's bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation.
A prospective controlled study was designed to determine if CBPM would reduce the number of HAPUs in patients treated in our medical intensive care unit. In 2 months, 422 patients were enrolled and assigned to beds equipped with or without a CBPM device. Patients' skin was assessed daily and weekly to determine the presence and progress of HAPUs. All patients were turned every 2 hours. CBPM patients were repositioned to off-load high-pressure points during turning, according to a graphic display. The number of newly formed HAPUs was the primary outcome measured. A χ(2) test was then used to compare the occurrence of HAPUs between groups.
HAPUs developed in 2 of 213 patients in the CBPM group (0.9%; both stage II) compared with 10 of 209 in the control group (4.8%; all stage II; P = .02).
Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs.
重症患者易发生医院获得性压疮（HAPU）。患者体位摆放是预防压疮的重要环节，因为它能减轻高压部位的压力。然而，这种体位摆放的效果存在争议。一种连续床边压力映射（CBPM）设备可通过压力感应垫在患者床边显示压力图像，提供最佳体位的实时反馈，从而减轻高压部位的压力，并可能预防HAPU的形成。
设计一项前瞻性对照研究，以确定CBPM是否能减少在我们医疗重症监护病房接受治疗的患者中HAPU的数量。在2个月内，招募了422名患者，并将其分配到配备或未配备CBPM设备的床位。每天和每周对患者的皮肤进行评估，以确定HAPU的存在和进展情况。所有患者每2小时翻身一次。根据图形显示，CBPM组患者在翻身时重新调整体位，以减轻高压点的压力。新形成的HAPU数量是主要测量结果。然后使用χ(2)检验比较两组之间HAPU的发生率。
CBPM组213例患者中有2例发生HAPU（0.9%；均为II期），而对照组209例中有10例发生（4.8%；均为II期；P = .02）。
CBPM组发生的HAPU明显少于对照组，表明实时视觉反馈在患者重新定位以预防新的HAPU形成方面是有效的。
