Bishopp Abigail, Oakes Amy, Antoine-Pitterson Pearlene, Chakraborty Biman, Comer David, Mukherjee Rahul
Department of Respiratory Medicine & Physiology, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
School of Mathematics, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Ulster Med J. 2019 Jan;88(1):17-20. Epub 2019 Jan 22.
Non-invasive ventilation (NIV) is a valuable treatment in the management of acute hypercapnic respiratory failure. NIV is not without risks. One such adverse effect is the development of pressure ulcers over the nasal bridge which have an incidence of up to 20% of patients requiring NIV in this setting. The role of medical devices in the development of hospital acquired pressure ulcers has been increasingly recognised with 10-35% of all hospital acquired ulcers attributed to medical devices. Guidelines on acute NIV use suggest good skin care strategies. However, data on the magnitude of the problem of nasal bridge pressure ulceration and the effect of proactive preventative steps remains scant.
A quality improvement project was designed to reduce the incidence of nasal bridge pressure ulcers during acute NIV. Hydrocolloid dressings were placed over the nasal bridge in all patients requiring NIV between 30 October 2015 and the 29 October 2016. Tissue viability was assessed daily with new pressure ulceration defined as grade 2 or above. Rates of nasal bridge pressure ulcers were compared to all patients requiring NIV in the 12-month period prior to intervention.
In Group 1, there were 161 admissions and 9 grade 2 pressure ulcers from 666 NIV bed-days. In Group 2 there were 134 admissions and 0 pressure ulcers from 718 NIV bed-days. There was a statistically significant reduction in grade 2 pressure ulceration rates (p= 0.0013) in Group 2 compared to Group 1.
Application of an early prophylactic pressure-relieving hydrocolloid nasal dressing reduces the risk of developing grade 2 pressure ulcers in patients in patients requiring acute NIV.
无创通气（NIV）是治疗急性高碳酸血症性呼吸衰竭的一种有效方法。然而，NIV并非毫无风险。其中一个不良反应是鼻梁处出现压疮，在此情况下，接受NIV治疗的患者中高达20%会出现压疮。医疗设备在医院获得性压疮的发生中所起的作用已得到越来越多的认识，所有医院获得性溃疡中有10 - 35%归因于医疗设备。关于急性NIV使用的指南建议采取良好的皮肤护理策略。然而，关于鼻梁压疮问题的严重程度以及积极预防措施的效果的数据仍然很少。
设计了一项质量改进项目，以降低急性NIV期间鼻梁压疮的发生率。在2015年10月30日至2016年10月29日期间，对所有需要NIV的患者在鼻梁处使用水胶体敷料。每天评估组织活力，新出现的压疮定义为2级或以上。将鼻梁压疮发生率与干预前12个月内所有需要NIV的患者进行比较。
第1组有161例入院患者，666个NIV床日中有9例2级压疮。第2组有134例入院患者，718个NIV床日中无压疮。与第1组相比，第2组2级压疮发生率有统计学显著降低（p = 0.0013）。
早期预防性应用减压水胶体鼻敷料可降低需要急性NIV的患者发生2级压疮的风险。
