Korompeli Anna, Karakike Eleni, Galanis Petros, Myrianthefs Pavlos
Department of Health Science, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Healthcare (Basel). 2025 Jul 11;13(14):1675. doi: 10.3390/healthcare13141675.
Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. To evaluate the impact of nursing-led mobilization protocols on the incidence and progression of PUs in critically ill patients. In this retrospective observational cohort study, 188 ICU patients were admitted during one of two consecutive periods of care: conventional care (6-hourly repositioning) and an advanced nursing-led protocol (3-hourly repositioning with support surfaces and specialized nurse training), which replaced conventional care as standard in our institution. The primary outcome included new PU development for patients with no pre-existing ulcers or worsening/non-progression of pre-existing ulcers at discharge; ICU mortality was evaluated as a secondary outcome. Among patients without pre-existing ulcers (n = 155), new PU incidence did not significantly differ between groups, even after adjusting for SOFA score (OR 0.40, 95% CI: 0.05 TO 3.17; = 0.374). However, in patients with pre-existing ulcers (n = 33), the advanced care group showed improvement (53.3% versus 0% in the conventional group, OR 0.07, 95% CI: 0.01-0.64; = 0.012); this effect was independent of initial SOFA score. Mortality was associated with the SOFA score, but not with the type of care. While advanced nursing-led mobilization did not reduce PU incidence, it significantly improved existing ulcer outcomes. Findings support the integration of structured protocols for high-risk ICU patients, especially those with existing ulcers.
压疮（PU）仍然是重症监护病房（ICU）环境中普遍存在的并发症，尤其是在行动不便的患者中。结构化的、由护士主导的活动方案对压疮预防和恢复的影响仍未得到充分研究。为了评估由护士主导的活动方案对重症患者压疮发生率和进展的影响。在这项回顾性观察队列研究中，188名ICU患者在两个连续护理期之一入院：常规护理（每6小时翻身）和先进的由护士主导的方案（每3小时翻身并使用支撑面和专业护士培训），该方案在我们机构取代常规护理成为标准护理。主要结局包括无既往溃疡患者新发压疮，或出院时既往溃疡恶化/无进展；ICU死亡率作为次要结局进行评估。在无既往溃疡的患者（n = 155）中，即使在调整序贯器官衰竭评估（SOFA）评分后，两组之间新发压疮发生率也无显著差异（比值比[OR]0.40，95%置信区间[CI]：0.05至3.17；P = 0.374）。然而，在有既往溃疡的患者（n = 33）中，先进护理组显示出改善（常规组为零，先进护理组为53.3%，OR 0.07，95% CI：0.01 - 0.64；P = 0.012）；这种效果独立于初始SOFA评分。死亡率与SOFA评分相关，但与护理类型无关。虽然由护士主导的先进活动方案并未降低压疮发生率，但它显著改善了现有溃疡的结局。研究结果支持将结构化方案纳入高危ICU患者，尤其是那些有现有溃疡的患者。
