血管加压药对危重症患者压疮发展的影响：系统评价。

Effects of vasopressor agents on the development of pressure ulcers in critically ill patients: a systematic review.

机构信息

School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Ireland.

Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Ireland.

出版信息

J Wound Care. 2022 Mar 2;31(3):266-277. doi: 10.12968/jowc.2022.31.3.266.

DOI:10.12968/jowc.2022.31.3.266

PMID:35199593

Abstract

OBJECTIVE

The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU.

METHOD

A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool.

RESULTS

The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47-88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76μg/min, 95% CI: 6.06-11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10-15.82; p<0.00001). The overall validities of the studies varied between 45-90%, meaning that there is potential for bias within all the included studies.

CONCLUSION

Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper.

摘要

目的

本系统评价的主要目的是确定血管加压剂对重症监护病房（ICU）中危重病患者发生压疮（PU）的影响。次要结局是 ICU 住院时间。

方法

使用搜索的数据库进行系统评价：Medline、Embase、CINAHL 和 The Cochrane Library。采用系统评价和荟萃分析报告的首选项目制定综述。使用预设的数据提取表提取数据，并使用 RevMan 进行适当分析。使用 EBL 批判性评价工具进行质量评估。

结果

纳入标准符合 13 项研究。有两项研究提供了足够的数据来比较使用和不使用血管加压剂的患者中 PU 发生的数量。这两项研究一致表明，使用血管加压剂增加了 PU 发展的可能性。RevMan 分析表明，血管加压剂的给药时间较短与 PU 发生较少相关（平均差异（MD）65.97 小时，95%置信区间（CI）：43.47-88.47；p=0.0001）。此外，较低剂量的血管加压剂也与 PU 发生较少相关（MD：8.76μg/min，95% CI：6.06-11.46；p<0.00001）。与无 PU 患者相比，有 PU 患者的 ICU 住院时间平均增加 11.46 天（MD：11.46 天；95% CI：7.10-15.82；p<0.00001）。所有纳入研究的整体有效性在 45%-90%之间，这意味着所有纳入研究都存在潜在的偏倚。