Gou Ling, Zhang Zhiqin, A Yongde
Department of Gastrointestinal surgery, Xining, China.
Intensive Care Unit, Qinghai Provincial People's Hospital, Xining, China.
PLoS One. 2023 Jun 23;18(6):e0287326. doi: 10.1371/journal.pone.0287326. eCollection 2023.
Medical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with ICU patients through systematic review and meta-analysis, and provide insights into the clinical prevention of MDRPI.
We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China BioMedical Literature Database (CBM) (from inception to January 2023) for studies that identified risk factors of MDRPI in ICU patients. In order to avoid the omission of relevant literature, we performed a secondary search of the above database on February 15, 2023. Meta-analysis was performed using Revman 5.3.
Fifteen studies involving 4850 participants were selected to analyze risk factors for MDRPI in ICU patients. While conducting a meta-analysis, we used sensitivity analysis to ensure the reliability of the results for cases with significant heterogeneity among studies. When the source of heterogeneity cannot be determined, we only described the risk factor. The risk factors for MDRPI in ICU patients were elder age (OR = 1.06, 95% CI: 1.03-1.10), diabetes mellitus (OR = 3.20, 95% CI: 1.96-5.21), edema (OR = 3.62, 95% CI: 2.31-5.67), lower Braden scale score (OR = 1.22, 95%CI: 1.11-1.33), higher SOFA score (OR = 4.21, 95%CI: 2.38-7.47), higher APACHE II score (OR = 1.38, 95%CI: 1.15-1.64), longer usage time of medical devices (OR = 1.11, 95%CI: 1.05-1.19), use of vasoconstrictors (OR = 6.07, 95%CI: 3.15-11.69), surgery (OR = 4.36, 95% CI: 2.07-9.15), prone position (OR = 24.71, 95% CI: 7.34-83.15), and prone position ventilation (OR = 17.51, 95% CI: 5.86-52.36). Furthermore, we found that ICU patients who used subglottic suction catheters had a higher risk of MDRPI, whereas ICU patients with higher hemoglobin and serum albumin levels had a lower risk of MDRPI.
This study reported the risk factors for MDRPI in ICU patients. A comprehensive analysis of these risk factors will help to prevent and optimize interventions, thereby minimizing the occurrence of MDRPI.
重症监护病房（ICU）患者发生的与医疗器械相关的压力性损伤（MDRPI）是一个严重问题。我们旨在通过系统评价和荟萃分析评估ICU患者发生MDRPI的危险因素，并为MDRPI的临床预防提供见解。
我们检索了PubMed、Embase、Web of Science、中国知网（CNKI）、万方数据库和中国生物医学文献数据库（CBM）（从创刊至2023年1月），以查找确定ICU患者MDRPI危险因素的研究。为避免遗漏相关文献，我们于2023年2月15日对上述数据库进行了二次检索。使用Revman 5.3进行荟萃分析。
选取15项涉及4850名参与者的研究，分析ICU患者发生MDRPI的危险因素。在进行荟萃分析时，我们使用敏感性分析以确保研究间存在显著异质性情况下结果的可靠性。当无法确定异质性来源时，我们仅描述危险因素。ICU患者发生MDRPI的危险因素包括年龄较大（OR = 1.06，95%CI：1.03 - 1.10）、糖尿病（OR = 3.20，95%CI：1.96 - 5.21）、水肿（OR = 3.62，95%CI：2.31 - 5.67）、Braden量表评分较低（OR = 1.22，95%CI：1.11 - 1.33）、序贯器官衰竭评估（SOFA）评分较高（OR = 4.21，95%CI：2.38 - 7.47）、急性生理与慢性健康状况评分系统II（APACHE II）评分较高（OR = 1.38，95%CI：1.15 - 1.64）、医疗器械使用时间较长（OR = 1.11，95%CI：1.05 - 1.19）、使用血管收缩剂（OR = 6.07，95%CI：3.15 - 11.69）、手术（OR = 4.36，95%CI：2.07 - 9.15）、俯卧位（OR = 24.71，95%CI：7.34 - 83.15）以及俯卧位通气（OR = 17.51，95%CI：5.86 - 52.36）。此外，我们发现使用声门下吸引导管的ICU患者发生MDRPI的风险较高，而血红蛋白和血清白蛋白水平较高的ICU患者发生MDRPI的风险较低。
本研究报告了ICU患者发生MDRPI的危险因素。对这些危险因素进行综合分析将有助于预防和优化干预措施，从而最大限度减少MDRPI的发生。
