Ross Paul, Du Plooy Darrel, Sheldrake Jayne, Ronayne Laura, Keogh Padraig, Collins Kathleen, Simpson Alex, Pilcher David, Udy Andrew
Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia.
Crit Care Resusc. 2024 Nov 22;26(4):227-240. doi: 10.1016/j.ccrj.2024.08.001. eCollection 2024 Dec.
To describe the epidemiology and clinical features of pressure injury (PI) development in adult patients supported with extracorporeal membrane oxygenation (ECMO).
Retrospective, observational, cohort study from January 2018 to May 2023.
A single-centre high-volume ECMO specialist intensive care unit (ICU).
All adults (aged 18 y or more) admitted to ICU for more than 24 h.
Any PI developing more than 24 h after ICU admission.
Five-hundred ICU patients were supported with ECMO during the study period. Excluding those <18 years of age and with an ICU length of stay of <24 h, 466 patients were included in the analysis. One-hundred-thirty-five (29.0%) patients acquired at least one PI during their ICU stay, with PI occurring in 80 patients (17.2%) whilst supported on ECMO. The PI incidence rate was 1.7 per 100 ECMO patient-days (confidence interval: 1.3-2.0). Patients with a PI were mechanically ventilated for longer, received more renal replacement therapy, manifested more delirium, and stayed longer in the ICU and hospital. Conversely, crude ICU and in-hospital mortality was lower in the PI group. A longer ECMO run time and a higher proportion of veno-venous ECMO was also noted in those with a PI. Factors independently associated with the acquisition of a PI were male gender, oral dietary intake, renal replacement therapy, and prolonged mechanical ventilation. The majority of the PIs acquired during ECMO were stage-two and were most commonly located on the neck and head ( = 25/96 PIs, 26.0%) and sacral region ( = 31/96 PIs, 32.3%). Only three PIs were in relation to the ECMO cannula, circuit, or dressing.
A significant proportion of patients develop PIs while receiving ECMO. Vigilance on the prevention of medical device related PI is required. Gender, renal replacement therapy, oral diet, and length of mechanical ventilation were independent predictors for PI development in this population.
描述接受体外膜肺氧合（ECMO）支持的成年患者发生压力性损伤（PI）的流行病学特征和临床特点。
2018年1月至2023年5月的回顾性观察队列研究。
一家单中心大容量ECMO专科重症监护病房（ICU）。
所有入住ICU超过24小时的成年人（年龄18岁及以上）。
ICU入院24小时后发生的任何PI。
在研究期间，500例ICU患者接受了ECMO支持。排除年龄<18岁和ICU住院时间<24小时的患者后，466例患者纳入分析。135例（29.0%）患者在ICU住院期间至少发生1次PI，其中80例（17.2%）患者在接受ECMO支持时发生PI。PI发生率为每100个ECMO患者日1.7例（置信区间：1.3 - 2.0）。发生PI的患者机械通气时间更长，接受更多的肾脏替代治疗，谵妄表现更多，在ICU和医院的住院时间更长。相反，PI组的ICU和院内粗死亡率较低。PI患者的ECMO运行时间也更长，且静脉 - 静脉ECMO的比例更高。与发生PI独立相关的因素为男性、经口饮食摄入、肾脏替代治疗和机械通气时间延长。在ECMO期间发生的PI大多数为2期，最常见于颈部和头部（25/96例PI，26.0%）以及骶尾部（31/96例PI，32.3%）。仅3例PI与ECMO插管、管路或敷料有关。
相当一部分患者在接受ECMO治疗时发生PI。需要警惕预防与医疗器械相关的PI。性别、肾脏替代治疗、经口饮食和机械通气时间是该人群PI发生的独立预测因素。
