Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Is cerebral oximetry necessary for patients undergoing orthopedic operation for rehabilitate hip fractures?: Which is her role in preventing cerebral hypoxia and appearance of neurocognitive disfunctions?

Aim: This study was conducted to evaluate baseline rSO2 values, identify factors that could potentially influence them, evaluate perioperative and postoperative changes in rSO2 values and validate whether monitoring rSO2 values is needed in patients with hip fractures. Methods: This is a prospective observational study on 69 patients. Data were collected on factors potentially related to baseline rSO2 values. Collected and stored data referred to rSO2 values from baseline until early postoperative period, MMSE score preoperatively and 7 days postoperatively, appearance of postoperative excitation or confusion and their pharmaceutical treatment, as well as to the type of anesthesia. Data were analyzed with student’s t test, Pearson correlation and multiple regression analysis as appropriate. Results: The mean age of our patients is 74 ±13 years. A significant correlation between baseline rSO2 L and baseline rSO2 R values (r=0,852, p<0,001) was observed. Mean baseline rSO2 L was 60 ± 10. The percentage of the patients with baseline rSO2 < 55 was 31, 9%. Baseline rSO2 has a positive correlation with hematocrit (r=0,50 , p<0,001) and SpO2 (r= 0,587 , p<0,001) and a negative correlation with ASA (r=-0,42, p<0,001) and age (r=-0,39, p=0,001). From regression analysis resulted that SpO2 is responsible for the 35 % of the variance on baseline rSO2 values (R2=0,35) and preoperative hematocrit for the 23% (R2= 0,23). Age, hematocrit and ASA together are responsible for the 39% of the variance on baseline rSO2 values (R2=0,39). SpO2 together with hematocrit and age can predict the 55% (R2=0,55) of the baseline rSO2 values. No difference was observed on rSO2 values between patients that underwent general or regional anesthesia. rSO2 values were significantly improved on every measurement during and after surgery. Cerebral desaturations had the 40 % of the patients. There was no correlation between low rSO2 values and hospital stay, but patients with baseline rSO2 <55% needed more medicine to treat their postoperative excitation. Conclusion: The high percentage of low baseline rSO2 values and desaturations as well as the correlation between rSO2 values and pharmaceutical treatment for the postoperative excitation or confusion, indicates the need of these patients to be assessed with cerebral oximetry monitoring. The baseline rSO2 values can be predicted in high percentage by the patient’s age, hematocrit, SpO2 and ASA classification. More and larger studies are needed to define the usefulness of cerebral oximetry in this group of patients with hip fractures and also whether this monitoring can contribute to a better preoperative preparationΣκοπός: Αυτή η μελέτη διεξήχθη για να εκτιμήσει τις βασικές τιμές του rSO2, να προσδιορίσει παράγοντες που μπορούν να τις επηρεάσουν, να μελετήσει διεγχειρητικές και μετεγχειρητικές μεταβολές της εγκεφαλικής οξυμετρίας και να απαντήσουμε στο κατά πόσο κρίνεται απαραίτητη η χρήση εγκεφαλικής οξυμετρίας στην ομάδα ασθενών με κατάγματα ισχίου. Μέθοδος: Πρόκειται για μια προοπτική μελέτη παρατήρησης σε 69 ασθενείς. Συλλέχθηκαν δεδομένα πάνω σε παράγοντες δυνητικά σχετιζόμενους με τις βασικές τιμές rSO2. Έγινε καταγραφή του rSO2 από τις βασικές τιμές μέχρι και την άμεση μετεγχειρητική πορεία, του MMSE προεγχειρητικά και 7 μέρες μετεγχειρητικά, της μετεγχειρητικής σύγχυσης και διέγερσης και της φαρμακευτικής αντιμετώπισής τους, όπως και το είδος της αναισθησίας. Η ανάλυση των δεδομένων έγινε με τη χρήση του student’s t test, τη συσχέτιση Pearson και την πολλαπλή ανάλυση παλινδρόμησης. Αποτελέσματα: Η μέση ηλικία των ασθενών μας ήταν 74 ± 13 έτη. Μεταξύ baseline rSO2 L και rSO2 R παρατηρήθηκε σημαντική συσχέτιση ( r=0,852, p<0,001). Οι μέσες τιμές του rSO2 L είναι 60 ± 10. Το ποσοστό των ασθενών με baseline rSO2 < 55 ήταν 31,9%. Παρατηρήθηκε θετική σχέση του baseline rSO2 με τον αιματοκρίτη (r=0,50 , p<0,001) και το SpO2 (r= 0,587, p<0,001). Αρνητική συσχέτιση βρέθηκε με την ταξινόμηση κινδύνου κατά ASA (r=-0,42 , p<0,001) και την ηλικία (r=-0,39, p=0,001). Από την ανάλυση παλινδρόμησης προκύπτει ότι το SpO2 είναι υπεύθυνο για το 35 % της διακύμανσης των τιμών του baseline rSO2 L (R2=0,35), ο αιματοκρίτης για το 23 % (R2=0,23). Η ηλικία, ο αιματοκρίτης και η κατάταξη ASA είναι υπεύθυνοι για το 39 % της διακύμανσης των τιμών του baseline rSO2 (R2=0,39). Το SpO2, η αιμοσφαιρίνη και η ηλικία ευθύνονται για το 55% (R2=0,55) της διακύμανσης του baseline rSO2. Δεν παρατηρήθηκε διαφορά στις τιμές του rSO2 μεταξύ των ασθενών που έλαβαν γενική ή περιοχική αναισθησία. Οι τιμές του rSO2 ήταν σημαντικά βελτιωμένες στα σημεία μέτρησης και μετεγχειρητικά. Εγκεφαλικοί αποκορεσμοί παρουσιάστηκαν στο 40 % των ασθενών. Δεν παρατηρήθηκε συσχέτιση μεταξύ χαμηλών τιμών rSO2 και παραμονής στο νοσοκομείο, όμως oι ασθενείς με baseline rSO2 <55% χρειάστηκαν μεγαλύτερο αριθμό φαρμάκων για την αντιμετώπιση της μετεγχειρητικής διέγερσης. Συμπέρασμα: Το υψηλό ποσοστό χαμηλών τιμών baseline rSO2 και αποκορεσμών, όπως και η σχέση μεταξύ των τιμών της εγκεφαλικής οξυμετρίας και της φαρμακευτικής αντιμετώπισης της μετεγχειρητικής σύγχυσης και διέγερσης, υποδεικνύει την αναγκαιότητα παρακολούθησης των ασθενών αυτών με τη μέθοδο αυτή. Περισσότερες μελέτες με μεγαλύτερο αριθμό ασθενών είναι απαραίτητες για να καθοριστεί αφενός μεν η χρησιμότητα της εγκεφαλικής οξυμετρίας στην ομάδα ασθενών με κατάγματα ισχίου, αφετέρου εάν η μέθοδος αυτή μπορεί να συμβάλει στην καλύτερη προεγχειρητική προετοιμασία

Auricular Acupuncture Analgesia in Thoracic Trauma: A Case Report

AbstractWe report a case of thoracic trauma (rib fractures with pneumothorax and pulmonary contusions) with severe chest pain leading to ineffective ventilation and oxygenation. The patient presented to our emergency department. The patient had chronic obstructive pulmonary disease and was completely unable to take deep breaths and clear secretions from his bronchial tree. After obtaining informed consent, we applied auricular acupuncture to ameliorate pain and hopefully improve his functional ability to cough and breathe deeply. Within a few minutes, his pain scores diminished considerably, and his ventilation and oxygenation indices improved to safe limits. Auricular acupuncture analgesia lasted for several hours. Parallel to pain reduction, hemodynamic disturbances and anxiety significantly resolved. A second treatment nearly a day later resulted in almost complete resolution of pain that lasted at least 5 days and permitted adequate ventilation, restored oxygenation, and some degree of mobilization (although restricted due to a compression fracture of a lumbar vertebra). Nonopioid and opioid analgesics were sparsely used in low doses during the entire hospitalization period. Hemodynamic alterations and anxiety also decreased, and the patient was soon ready to be discharged

Electroacupuncture for the Treatment of Calcific Tendonitis. A Pilot Study

Current treatment for calcific tendonitis consists of arm rest, antiinflammatory medications, and corticosteroid injections. If unsuccessful, a lot of clinicians suggest several physiotherapy modalities, such as shockwave therapy and electrotherapy. The purpose of our study was to assess the efficacy of electroacupuncture, as a substitute for failed medical treatment in calcific tendonitis.In a pilot study, we prospectively followed 10 patients treated with electroacupuncture for calcific tendonitis who failed to respond to medical treatment. Its efficacy was assessed by evaluating the level of pain, the Beck Depression Inventory, the range of active elbow mobility, and by repeated radiological evaluation of the course of calcific deposits. All clinical and radiological observations were recorded before and within 6 months after the onset of treatment.After electroacupuncture treatment (2 Hz, 180 mA for 30–60 seconds at GB21, GB34, LI4, LI 14, LI15, TW5, TW14, Chien Chien SI9, SI12, S37, S38), the visual analog score decreased notably, and the range of motion returned to normal. Radiological evaluation demonstrated almost complete absorption of calcific deposits within 6 months, after treatment.We conclude that electroacupuncture relieved skeletal pain, improved the quality of patient's life, and contributed to total regression of the calcific depositions in followed patients. So, electroacupuncture may be a valuable treatment option for calcific tendonitis, when medical treatment fails to relieve symptoms. Keywords: calcific tendonitis, electroacupuncture, electrotherapy, medical treatmen

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat