Intensive Care Unit, Northern Hospital, Melbourne, Victoria, Australia.
Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.
Int Wound J. 2020 Aug;17(4):1028-1038. doi: 10.1111/iwj.13365. Epub 2020 Apr 18.
The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side-lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose-designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose-designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high-risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z-Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side-lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°-26°, the foam wedge 29°-27°, and the pillow 23°-21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°-71°, a difference of 7°) and the pillow alone (79°-74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°-86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.
在重症监护病房（ICU）环境中，压力性损伤的患病率很高，发生率从 13.1%到 45.5%不等。评估预防压力性损伤的干预措施应该参考初步研究结果，以确定在未来试验设计中应考虑的因素。本研究的目的是评估 ICU 中参与者的招募和监测过程；测量使用专门设计的定位装置和常规护理设备时，处于无活动能力的危重症患者的身体角度（侧卧倾斜位置）和头部及颈部对齐角度（仰卧位置）的维持情况；确定使用专门设计的定位装置和常规护理设备为患者定位所需的时间。这是一项在澳大利亚维多利亚州的 ICU 中进行的前瞻性、观察性、可行性研究。样本为处于高压力性损伤风险的无活动能力的成年危重症患者。常规护理干预措施包括枕头、泡沫楔形物和卷起的毛巾，干预装置是 Z-Flo 液流定位器。在六次（基线时、1 小时和 2 小时）测量身体角度和头部及颈部对齐角度。还测量了定位所需的时间。样本主要为男性（n=5，62%），平均年龄为 59 岁。大多数患者（n=106，92.2%）无活动能力，因此不符合参与条件。共观察了 48 次翻身和定位干预措施。对于侧卧倾斜位置，所有设备从基线到 2 小时的差异不超过三度（液流定位器 25°-26°、泡沫楔形物 29°-27°和枕头 23°-21°）。对于头部和颈部位置，从基线到 2 小时的差异最大的是枕头和卷起的毛巾（78°-71°，相差 7°）和单独使用枕头（79°-74°，相差 5°）。液流定位器的差异最小（84°-86°，相差 2°）。未来在 ICU 中评估定位设备的研究应考虑患者的入选特征，特别是无活动能力。建议开展初步研究，为更大规模的压力性损伤预防试验的设计提供信息。
