Yesantharao Pooja S, El Eter Leen, Javia Vidhi, Werthman Emily, Cox Carrie, Keenan Julie, Moseley Rachel, Orosco Rowena, Cooney Carisa, Caffrey Julie
Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Burn Care Res. 2021 Aug 4;42(4):610-616. doi: 10.1093/jbcr/irab061.
Although prior studies have demonstrated the utility of real-time pressure mapping devices in preventing pressure ulcers, there has been little investigation of their efficacy in burn intensive care unit (BICU) patients, who are at especially high risk for these hospital-acquired injuries. This study retrospectively reviewed clinical records of BICU patients to investigate the utility of pressure mapping data in determining the incidence, predictors, and associated costs of hospital-acquired pressure injuries (HAPIs). Of 122 patients, 57 (47%) were studied prior to implementation of pressure mapping and 65 (53%) were studied after implementation. The HAPI rate was 18% prior to implementation of pressure monitoring, which declined to 8% postimplementation (chi square: P = .10). HAPIs were less likely to be stage 3 or worse in the postimplementation cohort (P < .0001). On multivariable-adjusted regression accounting for known predictors of HAPIs in burn patients, having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95% CI 1.0-1.5, P = .04). Patients who developed HAPIs were significantly more likely to have had unsuccessful repositioning efforts in comparison to those who did not (P = .02). Finally, implementation of pressure mapping resulted in significant cost savings-$6750 (standard deviation: $1008) for HAPI-related care prior to implementation, vs $3800 (standard deviation: $923) after implementation, P = .008. In conclusion, the use of real-time pressure mapping decreased the morbidity and costs associated with HAPIs in BICU patients.
尽管先前的研究已经证明了实时压力映射设备在预防压疮方面的效用，但对于烧伤重症监护病房（BICU）患者（这些患者发生这些医院获得性损伤的风险特别高），其疗效的研究却很少。本研究回顾性分析了BICU患者的临床记录，以探讨压力映射数据在确定医院获得性压力损伤（HAPI）的发生率、预测因素和相关成本方面的效用。122名患者中，57名（47%）在压力映射实施前接受研究，65名（53%）在实施后接受研究。在压力监测实施前，HAPI发生率为18%，实施后降至8%（卡方检验：P = 0.10）。在实施后队列中，HAPI为3期或更严重程度的可能性较小（P < 0.0001）。在对烧伤患者中已知的HAPI预测因素进行多变量调整回归分析时，在一个区域至少有12小时持续压力负荷会显著增加该区域发生压力损伤的几率（优势比1.3，95%置信区间1.0 - 1.5，P = 0.04）。与未发生HAPI的患者相比，发生HAPI的患者重新定位未成功的可能性显著更高（P = 0.02）。最后，压力映射的实施带来了显著的成本节约——实施前HAPI相关护理的成本为6750美元（标准差：1008美元），实施后为3800美元（标准差：923美元），P = 0.008。总之，实时压力映射的使用降低了BICU患者中与HAPI相关的发病率和成本。
