Pediatric Working Group of the Commission for the Prevention and Treatment of Pressure Ulcer and Wounds. Regional University Hospital of Malaga, Spain; Pediatric Intensive Care Unit. Regional University Hospital of Malaga, Spain.
Department of Nursing. University of Valencia, Spain; Nursing Care Research Group. INCLIVA Biomedical Research Institute, Spain.
J Tissue Viability. 2020 Nov;29(4):310-318. doi: 10.1016/j.jtv.2020.08.005. Epub 2020 Aug 28.
To evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations.
The skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated.
Quasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention).
A sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05).
The application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.
评估一项旨在降低儿科重症监护病房患儿定位相关压力性损伤发生率和严重程度的预防策略。次要目标是评估预防建议的依从性。
与成人相比，婴儿或儿童的皮肤具有重要的生理和解剖差异。此外，儿科重症监护病房中皮肤不成熟、活动和移动能力有限以及医疗设备施加的压力等因素增加了婴儿和儿童患压疮的风险。需要评估针对这一重症监护人群的最有效预防措施。
采用连续抽样的准实验前后研究。基于最新证据（干预组）与非标准化护理（对照组），评估护理包实施的效果。参与研究的患儿为有发生压力性损伤风险且入住儿科重症监护病房（三级）超过 48 小时的 14 岁以下患儿。为了收集数据，查阅了两个计算机程序和每位参与者的医院临床记录。每组的资料收集期为 6 个月（干预前后）。
共纳入 110 例患儿（对照组 50 例，干预组 60 例）。暴露于压力性损伤风险的儿科患者的累积发病率从 16%降至 13.3%；在住院时间延长（≥28 天）的亚组中，发病率从 55.55%降至 20%。在干预组，完全消除了 3 级和 4 级压力性溃疡。此外，压力性损伤总数减少了 21.43%。记录的依从性最高的护理带建议是：皮肤检查、应用过氧脂肪酸和使用特殊支撑表面。研究期间发现的主要危险因素是俯卧位（p<0.05）。
预防用护理包的应用可能是减少重症监护病房压力性损伤数量和严重程度的有效方法。最脆弱的亚组患者可能受益于这些资源的应用。
