Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
Enferm Clin (Engl Ed). 2023 Nov-Dec;33(6):424-431. doi: 10.1016/j.enfcle.2023.10.005. Epub 2023 Oct 28.
To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors.
Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression.
Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL.
There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
确定俯卧位（PP）患者中与依赖相关的皮肤损伤（DRSL）的发生率，并确定其诱发因素。
在两个多学科重症监护病房进行随访研究。纳入接受有创机械通气和入院时无皮肤损伤的俯卧位患者。我们记录了 3 种 DRSL：（压疮[PU]、湿性相关皮肤损伤[MASD]和摩擦损伤[FI]）、人口统计学变量、诊断、住院时间、PP 发作、体位变化、急性生理学和慢性健康疾病分类系统 II 评分（APACHE II）、入院时前白蛋白水平、体重指数（BMI）、糖尿病、高血压、吸烟、外周血管疾病（PVD）、血管活性药物、Braden 评分和死亡率。进行了单变量分析：卡方检验、t 检验或曼-惠特尼 U 检验。多变量分析：逻辑回归。
共纳入 49 例患者，共进行 170 次 PP。22 例患者出现 41 例 DRSL，累积发生率为 44.9%（95%CI：31.6-58.7）。PU 占 63.4%（面部 73.1%；II 期 76.9%），12.2%为 MASD（腹股沟 60%；II 期 60%），24.4%为 FI（胸部 50%；III 期 70%）。损伤组（LG）的中位年龄为 66.5[61.8-71.3]岁，而非损伤组（NLG）为 64[43-71]岁，p=0.04。LG 中 80%有 PVD，而 NLG 中仅 20%，p=0.03。LG 的总俯卧位时间中位数为 96.9[56.1-149.4]小时，NLG 为 38.2[18.8-57]小时，p<0.001。多变量分析选择总俯卧位时间（OR=1.03；95%CI：1.01-1.05）和 PVD（OR=8.9；95%CI：1.3-58.9）作为发生 DRSL 的诱发因素。
俯卧位依赖性皮肤损伤发生率较高，主要为压力性损伤，但严重程度较低。俯卧位时间累积和外周血管疾病有利于其发展。
