Coyer F, Clark M, Slattery P, Thomas P, McNamara G, Edwards C, Ingleman J, Stephenson J, Ousey K
Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Queensland, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.
School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
J Wound Care. 2017 Oct 2;26(10):583-592. doi: 10.12968/jowc.2017.26.10.583.
To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR.
This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates.
We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091).
Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.
评估健康成年人和重症患者中患者体位、体重指数（BMI）、患者体温、界面压力（IP）与组织再灌注（TR）之间的关系。同时确定重症患者中序贯器官衰竭评估（SOFA）评分、预测压力性损伤风险的Braden量表评分、急性生理与慢性健康状况评分系统II（APACHE II）疾病严重程度分类评分、IP与TR之间的关系。
本研究在澳大利亚一家三级医院的一个拥有27张床位的重症监护病房（ICU）进行。在骶骨和大转子处测量IP和TR结果。使用TR的峰值压力指数（PPI）、峰值时间（PT）、稳定时间常数（STC）和标准化充血面积（NHA）测量值作为结果，进行重复测量方差分析（ANOVA）和双多元重复测量ANOVA。将参与者类型、体重指数（BMI）、Braden和APACHE II评分以及患者体温视为组间因素和协变量。
我们招募了23名低危和高危ICU患者以及9名健康成年志愿者。并非所有ICU患者都能获得IP读数。从所有招募的患者中收集了TR读数，但并非所有TR测量值都是相互不相关的。在控制年龄后，不同参与者类型的PPI读数存在差异（p = 0.093），最高值与高危患者相关，最低值与健康成年人相关；在控制年龄和BMI后，这种关联并不显著。年龄是一个显著变量（p = 0.008），年龄较大的参与者得分高于年龄较小的参与者。未观察到任何测量参数与TR变量之间存在统计学显著关联。然而，发现体温与TR相关（p = 0.091）。
尽管本初步分析的效能不足以检测到显著影响，但已确定了几个重要的关联，在低危和高危ICU患者之间以及ICU患者与健康志愿者之间观察到了结果差异。
