Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK; Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4029, Australia.
School of Nursing, Queensland University of Technology, Australia.
Intensive Crit Care Nurs. 2022 Feb;68:103155. doi: 10.1016/j.iccn.2021.103155. Epub 2021 Nov 1.
To report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries.
A prospective observational design where observations of patients' skin integrity were conducted on one day each week for 52 weeks.
The study was conducted in the 36-bed intensive care unit of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ.
The primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded.
Over the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI. The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09-1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02-1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18-3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01-1.09, p = 0.013).
Device related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.
报告重症监护病房成年危重患者中与器械相关的压力性损伤的纵向患病率，并探讨与器械相关压力性损伤发生相关的患者特征。
前瞻性观察设计，每周对患者的皮肤完整性进行一次观察，共 52 周。
本研究在澳大利亚昆士兰州一家主要大都市三级转诊医院的 36 张重症监护病房进行。该样本包括在观察前一天午夜前入住重症监护病房且有医疗器械在位的所有 18 岁或以上的患者。
主要结局指标是每周观察到的器械相关压力性损伤，并定义为在损伤部位有医疗器械使用史的皮肤或粘膜上发现的压力性损伤。记录患者的人口统计学和临床特征。
在研究期间，11.3%（71/631）的患者至少发生了一次医院获得性 DRPI。最常见的与损伤相关的器械是鼻胃/鼻空肠管（41%）和气管内导管（27%）。器械相关压力性损伤的显著预测因素是器械总数（OR 1.230，95%CI 1.09-1.38，p<0.001）、入住重症监护病房的时间长短（OR 1.05，95%CI 1.02-1.09，p=0.003）、男性（OR 2.099，95%CI 1.18-3.7，p=0.012）和入院时疾病严重程度评分增加（OR 1.044，95%CI 1.01-1.09，p=0.013）。
对于这一脆弱的患者群体，器械相关压力性损伤是一种常见的医源性问题。
