Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Patient safety coordinator, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Int Wound J. 2023 Apr;20(4):1205-1211. doi: 10.1111/iwj.13979. Epub 2022 Oct 21.
The objective of this cross-sectional descriptive study is to analyse the degree of compliance with the preventive measures for pressure injuries reported by an International Study Group in a cohort of adult critically ill patients. The level of risk of developing pressure injuries was determined using the Conscious level, Mobility, Hemodynamics, Oxygenation and Nutrition (COMHON) index. According to the level of risk, the preventive measures applied to each patient and scores on the different components of the index were recorded. Number, location and degree of pressure injuries were registered. Seventy-three patients (male: 68%) with an acute physiology and chronic health evaluation (APACHE) II: 12,1 ± 6,2 and 56,1% of them with invasive mechanical ventilation. The prevalence of pressure injuries was 21,9%, with 43,7% of sacral location and 75% of grade II. The level of risk using the COMHON index was distributed between low 30,1%, intermediate 23,3% and high 46,6%. The compliance range from 0% (offloading heel devices) to the use of active mattress and incontinence pads (100%). Regarding repositioning the degree of compliance varies (from 20% to 80%) according if patients with contraindications (4 points in subscale of Mobility) or those with the capacity to mobilise themselves (2 points in subscale of Mobility) are included in the denominator. We have found that in our ICU there is a wide range of compliance with the use of the preventive measures recommended by the International Study Group. Some of them are related not by the general score of the COMHON scale, but to that obtained in its subscale components.
本横断面描述性研究的目的是分析在一个成人危重症患者队列中,国际研究小组报告的预防压力性损伤措施的遵守程度。使用意识水平、移动性、血液动力学、氧合和营养(COMHON)指数确定发生压力性损伤的风险水平。根据风险水平,记录应用于每位患者的预防措施以及指数不同组成部分的得分。登记了压疮的数量、位置和程度。纳入 73 名(男性:68%)急性生理学和慢性健康评估(APACHE)Ⅱ评分:12.1±6.2 分,56.1%患者接受有创机械通气。压疮的患病率为 21.9%,其中 43.7%位于骶骨部位,75%为 2 级。使用 COMHON 指数的风险水平分布在低危 30.1%、中危 23.3%和高危 46.6%之间。依从性范围为 0%(卸除足跟减压装置)至使用主动床垫和失禁垫(100%)。关于翻身,根据是否存在移动性亚量表中存在 4 分(即存在禁忌症)或存在移动能力(即存在移动性亚量表中 2 分)的患者,其依从性程度在 20%至 80%之间有所不同。我们发现,在我们的 ICU 中,对国际研究小组推荐的预防措施的使用存在广泛的依从性。其中一些措施与 COMHON 量表的总体评分无关,而是与其子量表组成部分的评分有关。