Department of Respiratory Therapy, Rady Children's Hospital-San Diego, San Diego, California.
Division of Respiratory Medicine, Rady Children's Hospital-San Diego, University of California-San Diego, San Diego, California.
Respir Care. 2019 Dec;64(12):1455-1460. doi: 10.4187/respcare.06784. Epub 2019 Jul 23.
Noninvasive ventilation (NIV) contributes to the development of pressure injury in a significant number of hospitalized patients. Pressure injuries contribute to increased length of hospital stay, pain, infection, and disfigurement. This study examined the relationship between NIV use and pressure injuries in hospitalized subjects.
We retrospectively reviewed all patients on NIV at a tertiary-care children's hospital over a 2-y period. We studied the relationship between the characteristics of NIV use and measures of pressure injury severity.
A total of 255 subjects, mean ± SD age 11.3 ± 5.8 y with 343 episodes of NIV use were evaluated, 7.2% (25/343) of which were associated with pressure injury. In univariate analysis, the presence of pressure injury was associated with older age ( = .01), maximum leak ( = .01), 95th percentile leak ( = .01), the log duration of time on NIV until pressure injury formation ( = .01), and maximum inspiratory positive airway pressure level ( = .01). Maximum leak remained statistically significant after multivariable analysis.
After multivariate analysis, only high mask leak was significantly associated with developing a pressure injury. Identifying risk factors that correlate with NIV device-related hospital acquired pressure injuries in children can direct procedures to prevent pressure injury in hospitalized children at high risk.
在大量住院患者中，无创通气（NIV）会导致压力性损伤的发生。压力性损伤会导致住院时间延长、疼痛、感染和毁容。本研究探讨了住院患者中 NIV 使用与压力性损伤之间的关系。
我们回顾性分析了在一家三级儿童医院使用 NIV 的所有患者，时间跨度为 2 年。我们研究了 NIV 使用的特征与压力性损伤严重程度之间的关系。
共评估了 255 名平均年龄 ± 标准差为 11.3 ± 5.8 岁的患者，共 343 例 NIV 使用例次，其中 7.2%（25/343）与压力性损伤有关。在单因素分析中，压力性损伤的发生与年龄较大（ =.01）、最大漏气量（ =.01）、第 95 百分位漏气量（ =.01）、NIV 至压力性损伤形成的时间对数（ =.01）和最大吸气正压水平（ =.01）有关。多变量分析后，最大漏气量仍具有统计学意义。
多变量分析后，只有高面罩漏气量与发生压力性损伤显著相关。确定与儿童 NIV 设备相关的医院获得性压力性损伤相关的危险因素，可指导程序以预防高风险住院儿童的压力性损伤。
