Loudet Cecilia Inés, Marchena María Cecilia, Maradeo María Roxana, Fernández Silvia Laura, Romero María Victoria, Valenzuela Graciela Esther, Herrera Isabel Eustaquia, Ramírez Martha Teresa, Palomino Silvia Rojas, Teberobsky Mariana Virginia, Tumino Leandro Ismael, González Ana Laura, Reina Rosa, Estenssoro Elisa
Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina.
Disciplina de Farmacologia Aplicada, Seção de Terapia Intensiva, Facultad de Ciencias Médicas, Universidad Nacional de La Plata - La Plata, Buenos Aires, Argentina.
Rev Bras Ter Intensiva. 2017 Jan-Mar;29(1):39-46. doi: 10.5935/0103-507X.20170007.
: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients.
: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle".
: Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor.
: A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.
确定质量管理方案在降低重症监护患者压疮发生率及严重程度方面的有效性。
这是一项在外科重症监护病房进行的准实验性前后对照研究。纳入连续接受机械通气≥96小时的患者。一个“流程改进”团队设计了一个多方面的干预流程，包括一次教育课程、一份压疮检查表、一个用于损伤监测和决策的智能手机应用程序，以及一个“家庭预防套餐”。
预干预组纳入55例患者，后干预组纳入69例患者，这些组中压疮的发生率分别为41例（75%）和37例（54%）。在每个时期入院后，预干预组压疮发生的中位时间为4.5[4 - 5]天，后干预组为9[6 - 20]天。预干预组高级别压疮的发生率为27例（49%），后干预组为7例（10%），最后，出院时存在压疮的比例分别为38例（69%）和18例（26%）（所有比较p<0.05）。预干预组家庭参与率总计为9%，后干预组增至57%（p<0.05）。使用逻辑回归模型分析高级别压疮的预测因素。机械通气时间和器官衰竭的存在与压疮的发生呈正相关，而多方面干预方案起到保护因素的作用。
基于智能手机应用程序和家庭参与的质量方案可降低长期接受急性机械通气患者压疮的发生率及严重程度。
