Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Intensive Crit Care Nurs. 2023 Oct;78:103453. doi: 10.1016/j.iccn.2023.103453. Epub 2023 May 10.
To explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation.
Patients who developed facial pressure injuries due to non-invasive positive pressure ventilation at a teaching hospital in Taiwan from January 2016 to December 2021 were selected, resulting in a total of 108 patients in our case group. A control group was formed by matching each case by age and gender to three acute inpatients who had used non-invasive ventilation but had not developed facial pressure injuries, resulting in 324 patients in the control group.
This study was a retrospective case-control study. The characteristics of the patients who developed pressure injuries at different stages in the case group were compared, and the risk factors of non-invasive ventilation-related facial pressure injuries were then determined.
Higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale score, and lower albumin levels in the former group. The results of multivariate analysis from binary logistic regression involving the duration of non-invasive ventilation usage demonstrated that the patients who used this device for 4-9 days and 16 days were at greater risk of facial pressure injuries than those who used it for 3 days; in terms of the Braden scale score, higher Braden scale scores were correlated with a higher risk of facial pressure injuries. In addition, albumin levels lower than the normal range were correlated with a higher risk of facial pressure injuries.
Patients with pressure injuries at higher stages had a higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale scores, and lower albumin levels. Thus, a longer duration of non-invasive ventilation use, lower Braden scale scores, and lower albumin levels were also risk factors for non-invasive ventilation-related facial pressure injuries.
Our results serve as a useful reference for hospitals, both in creating training programs for their medical teams to prevent and treat facial pressure injuries and in drafting guidelines for assessing risk in order to prevent facial pressure injuries caused by non-invasive ventilation. The duration of device usage, Braden scale scores, and albumin levels in particular should be seriously monitored to reduce the occurrence of facial pressure injuries in acute inpatients treated with non-invasive ventilation.
探讨使用无创正压通气患者面部压力性损伤的特点和危险因素。
本研究选择了 2016 年 1 月至 2021 年 12 月期间，在台湾一家教学医院因无创正压通气而发生面部压力性损伤的患者，共 108 例患者纳入病例组。通过年龄和性别与未发生面部压力性损伤的 3 例急性住院患者匹配，形成对照组，共 324 例患者纳入对照组。
这是一项回顾性病例对照研究。比较病例组中不同阶段发生压力性损伤患者的特征，并确定无创通气相关面部压力性损伤的危险因素。
前一组患者的无创通气使用时间更长、住院时间更长、Braden 量表评分更低、白蛋白水平更低。多变量分析中，将无创通气使用时间纳入二元逻辑回归分析，结果显示，使用该设备 4-9 天和 16 天的患者发生面部压力性损伤的风险高于使用 3 天的患者；Braden 量表评分方面，较高的 Braden 量表评分与较高的面部压力性损伤风险相关。此外，白蛋白水平低于正常值与较高的面部压力性损伤风险相关。
高分期压力性损伤患者的无创通气使用时间更长、住院时间更长、Braden 量表评分更低、白蛋白水平更低。因此，较长的无创通气使用时间、较低的 Braden 量表评分和较低的白蛋白水平也是与无创通气相关的面部压力性损伤的危险因素。
本研究结果为医院提供了有用的参考，包括为医疗团队制定预防和治疗面部压力性损伤的培训计划，以及制定风险评估指南，以预防无创通气引起的面部压力性损伤。特别是应认真监测设备使用时间、Braden 量表评分和白蛋白水平，以降低急性住院患者接受无创通气治疗时面部压力性损伤的发生。
