Coyer Fiona, Gardner Anne, Doubrovsky Anna, Cole Rae, Ryan Frances Mary, Allen Craig, McNamara Greg
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Am J Crit Care. 2015 May;24(3):199-209. doi: 10.4037/ajcc2015930.
To test an interventional patient skin integrity bundle, the InSPiRE protocol, for reducing pressure injuries in critically ill patients in an Australian adult intensive care unit.
Before and after design: patients receiving the intervention (InSPiRE protocol) were compared with a similar control group who received standard care. Data collected included demographic and clinical variables, skin assessment, presence and stage of pressure injuries, and score on the Sequential Organ Failure Assessment (SOFA).
Overall, 207 patients were enrolled, 105 in the intervention group and 102 in the control group. Most patients were men (mean age, 55 years). The groups were similar on major demographic variables (age, SOFA scores, intensive care unit stay). Cumulative incidence of pressure injuries was significantly lower in the intervention group (18.1%) than in the control group (30.4%) for skin injuries ( [Formula: see text], P = .04) and mucous injuries (t = 3.27, P ≤ .001). Significantly fewer pressure injuries developed over time in the intervention group (log rank = 11.842, df = 1, P ≤ .001) and intervention patients had fewer skin injuries (> 3 pressure injuries/patient = 1/105) than did control patients (> 3 pressure injuries/patient = 10/102; P = .02).
The intervention group, receiving the InSPiRE protocol, had a lower cumulative incidence of pressure injuries, and fewer and less severe pressure injuries that developed over time. Systematic and ongoing assessment of the patient's skin and risk for pressure injuries as well as implementation of tailored prevention measures are central to preventing pressure injuries.
测试一种干预性患者皮肤完整性综合方案——InSPiRE方案，以减少澳大利亚一家成人重症监护病房中重症患者的压疮。
前后对照设计：将接受干预（InSPiRE方案）的患者与接受标准护理的类似对照组进行比较。收集的数据包括人口统计学和临床变量、皮肤评估、压疮的存在情况和分期，以及序贯器官衰竭评估（SOFA）评分。
总体而言，共纳入207例患者，干预组105例，对照组102例。大多数患者为男性（平均年龄55岁）。两组在主要人口统计学变量（年龄、SOFA评分、重症监护病房住院时间）方面相似。干预组皮肤损伤（[公式：见正文]，P = 0.04）和黏膜损伤（t = 3.27，P≤0.001）的压疮累积发生率显著低于对照组（分别为18.1%和30.4%）。随着时间的推移，干预组发生的压疮明显更少（对数秩检验=11.842，自由度=1，P≤0.001），且干预组患者的皮肤损伤少于对照组（>3处压疮/患者：干预组为1/105，对照组为10/102；P = 0.02）。
接受InSPiRE方案的干预组压疮累积发生率较低，且随着时间的推移发生的压疮数量更少、严重程度更低。对患者皮肤和压疮风险进行系统且持续的评估，以及实施针对性的预防措施是预防压疮的关键。
