Sleiwah Aseel, Nair Ganeshkrishna, Mughal Maleeha, Lancaster Katie, Ahmad Imran
Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK.
Department of Plastic Surgery, Guy's & St. Thomas' Hospital, London, UK.
Eur J Plast Surg. 2020;43(6):727-732. doi: 10.1007/s00238-020-01737-6. Epub 2020 Sep 15.
Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting.
A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality.
Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days.
The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication.Level of evidence: Level IV, risk/prognostic study.
面部压疮是一种罕见但严重的并发症。英国国家卫生与临床优化研究所（NICE）指南建议应对患者进行压疮风险评估，并采取措施预防此类并发症。在本研究中，我们报告了一系列在重症监护病房接受治疗的新冠病毒阳性患者使用两种气管插管固定装置后发生的口周压疮病例。
通过机构风险管理系统对16例确诊患有口周压疮的患者进行回顾性分析。数据参数包括患者人口统计学信息（年龄、性别、合并症、吸烟史和体重指数（BMI））。数据收集内容包括入住重症监护病房的指征、插管持续时间、用于固定气管插管的医疗设备类型、血管升压药和肾脏替代治疗的需求、是否存在其他相关溃疡、俯卧位持续时间和死亡率。
16例患者出现了与两种医疗设备（Insight、AnchorFast）使用相关的不同类型口周压疮。平均年龄为58.6岁。平均插管时间为18.8天。14例患者需要俯卧位，平均持续时间为5.2天。
用于固定气管插管的这两种设备与独特类型的面部压疮有关。应采取措施定期评估皮肤状况，避免使用与面部压疮高风险相关的设备。应提供相关知识和培训以预防此类严重并发症。证据水平：IV级，风险/预后研究。
