Luana Furtado Bueno, RN, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil.
Manuela de Mendonça Figueirêdo Coelho, PhD, Federal University of Ceará, Fortaleza, Ceará, Brazil.
J Wound Ostomy Continence Nurs. 2024;51(4):276-282. doi: 10.1097/WON.0000000000001081. Epub 2024 Jul 19.
The purpose of this study was to determine the incidence and identify potential risk factors for medical device-related pressure injury (MDRPI) in critically ill and hemodynamically unstable adults (patients classified class III or IV on the Therapeutic Intervention Scoring System-28; TISS-28).
Prospective cohort study.
The target population was critically ill adults who were using one or more medical devices and categorized as class III or IV on the TISS-28. The study sample comprised 77 participants followed daily until discharge, death, transfer, or lesion development. Data were collected from January to March 2020. The study setting was an intensive care unit with 40 beds in a large hospital in a municipality in the state of Minas Gerais, Brazil.
Sociodemographic and pertinent clinical data, pressure injury (PI) risk assessed using the Braden Scale for Pressure Sore Risk, and head-to-toe skin inspections were completed. The incidence rate of MDRPIs was calculated, and survival analyses were completed via the Kaplan-Meier method and Cox regression model.
Forty-nine of 77 participants developed an MDRPI, reflecting an incidence rate of 63.6%. Collectively, 71 MDRPIs occurred in these 49 participants. Univariate analysis indicated significant associations between MDRPI occurrences and level of consciousness ( P = < .001), use of tube holder for ventilation devices ( P = .013), nasal cannula ( P = .034), nasogastric cannula ( P = .034), presence of edema ( P = .001), infection ( P = .007), higher TISS score ( P = .047), and greater number of medical devices ( P = .022). Survival analysis indicated that a high or very high-risk score on the Braden Scale for Pressure Sore Risk ( P = .043) and edema ( P = .030) are risk factors for MDRPI occurrences in this vulnerable population.
The incidence rate of MDRPIs was 63.6%. The categories with the highest high or very high risk scores on the Braden Scale for Risk of Pressure Pain and Edema emerged as risk factors for MDRPI in this critically ill and vulnerable population.
本研究旨在确定重症且血流动力学不稳定的成年患者（Therapeutic Intervention Scoring System-28 评分系统分类为 III 类或 IV 类患者，即 TISS-28）中与医疗器械相关的压力性损伤（MDRPI）的发生率，并识别其潜在的危险因素。
前瞻性队列研究。
目标人群为使用一种或多种医疗器械且 TISS-28 评分系统分类为 III 类或 IV 类的重症成年患者。本研究样本由 77 名参与者组成，他们每天接受随访，直至出院、死亡、转科或发生病变。数据收集于 2020 年 1 月至 3 月。研究地点为巴西米纳斯吉拉斯州一家大型医院的 40 张床位的重症监护病房。
收集人口统计学和相关临床数据、使用压疮风险评估Braden 量表评估压力性损伤风险，以及进行从头到脚的皮肤检查。计算 MDRPI 的发生率，并通过 Kaplan-Meier 法和 Cox 回归模型进行生存分析。
77 名参与者中有 49 名发生了 MDRPI，发生率为 63.6%。在这 49 名参与者中，共有 71 例 MDRPI。单因素分析表明，MDRPI 发生与意识水平（P <.001）、呼吸机用管夹（P =.013）、鼻导管（P =.034）、鼻胃管（P =.034）、存在水肿（P =.001）、感染（P =.007）、TISS 评分较高（P =.047）和使用的医疗器械较多（P =.022）之间存在显著关联。生存分析表明，Braden 压疮风险评估量表中高危或极高危评分（P =.043）和水肿（P =.030）是该脆弱人群发生 MDRPI 的危险因素。
MDRPI 的发生率为 63.6%。Braden 压疮风险评估量表中风险评分较高或极高危，以及水肿的类别被确定为该重症且脆弱人群发生 MDRPI 的危险因素。
