Prevention and Treatment of Pressure Ulcers: Quick Reference Guide

Aviso de responsabilidade: Este guia de consulta rápida foi desenvolvido pelo National Pressure Ulcer Advisory Panel, pelo European Pressure Ulcer Advisory Panel e pela Pan Pacific Pressure Injury Alliance. Apresenta uma análise e avaliação abrangentes da melhor evidência disponível no momento da pesquisa da literatura relacionada com avaliação, diagnóstico, prevenção e tratamento das úlceras por pressão. As presentes recomendações apresentam orientações gerais para uma prática clínica adequada e devem ser implementadas por profissionais de saúde qualificados e sujeitas ao seu juízo clínico de cada situação tendo em conta as preferências individuais de cada doente e os recursos disponíveis. O guia deve ser implementado de forma culturalmente consciente e respeitosa de acordo com os princípios de proteção, participação e parceria.Prefácio: Este Guia de Consulta Rápida sumariza as recomendações e os excertos da evidência disponível sobre a prevenção e o tratamento das úlceras por pressão. A versão mais abrangente, Diretrizes da Prática Clínica, fornece uma análise detalhada e discussão da investigação existente, uma avaliação crítica dos pressupostos e conhecimentos da área e uma descrição da metodologia utilizada no desenvolvimento das diretrizes. Este Guia de Consulta Rápida destina-se a profissionais de saúde ocupados que necessitam de efetuar uma consulta rápida para prestarem cuidados em ambientes clínicos. Os utilizadores não devem usar excertos do Guia de Consulta Rápida de forma isolada. A primeira edição deste Guia foi desenvolvida ao longo de quatro anos de colaboração entre o National Pressure Ulcer Advisory Panel (NPUAP) e o European Pressure Ulcer Advisory Panel (EPUAP). Nesta segunda edição do Guia, a Pan Pacific Pressure Injury Alliance (PPPIA) juntou-se ao NPUAP e ao EPUAP. O objetivo desta colaboração internacional foi o de desenvolver recomendações baseadas em evidência para a prevenção e tratamento das úlceras por pressão que possam ser usadas por profissionais de saúde em todo o mundo. Foi utilizada uma metodologia científica específica para identificar e avaliar de forma crítica a investigação disponível. Na ausência de evidência definitiva, recorreu-se à opinião de peritos (muitas vezes fundamentada em evidência indireta e outras diretrizes) com vista à formulação de recomendações. As versões preliminares das recomendações e a evidência disponível foram disponibilizadas a 986 stakeholders convidados (pessoas individuais e organizações) em todo o mundo. A versão final do Guia baseia-se na investigação existente e na sabedoria acumulada do NPUAP, do EPUAP, da PPPIA e de parceiros internacionais. Nesta edição do Guia, a força de cada recomendação foi avaliada através de um processo de votação consensual (GRADE). A força da recomendação identifica a importância da recomendação com base no respetivo potencial para melhorar os resultados dos doentes. Indica também ao profissional de saúde o grau de confiança que poderá ter na recomendação para saber se esta será mais benéfica do que prejudicial. Pode ainda ser utilizada para auxiliar na priorização de intervenções relacionadas com úlceras por pressão.info:eu-repo/semantics/publishedVersio

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design. Survey was among pressure ulcer experts.Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated.Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning

Finite Element Analysis to model ischemia experienced in the development of device related pressure ulcers.

Pressure ulcers are a common occurrence of damage to skin. Severity ranges from slightly discoloured skin to full thickness tissue damage which can be fatal in some cases. Engineering effort, typically developing computational models had made significant progress in the understanding and demonstration of the formation mechanism of pressure ulcers with the aetiology of excessive stress however relatively limited attempts had been made to develop relevant models for pressure ulcers caused by ischemia. The aim of this paper is to present evidence of a computational model developed to simulate ischemic pressure ulcer formation and demonstrate the established relationship between the computational data and the acquired clinically relevant experimental data by utilising laser Doppler velocimetry. The application of the presented computational model and the established relationship allows the evaluation of the effect of a mechanical loading to the cutaneous blood flow velocity which is a step closing to understand and evaluate a mechanical load to the formation of pressure ulcers caused by ischemia

Hybrid Equation/Agent-Based Model of Ischemia-Induced Hyperemia and Pressure Ulcer Formation Predicts Greater Propensity to Ulcerate in Subjects with Spinal Cord Injury

Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation. © 2013 Solovyev et al

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers : PRESSURE (pressure relieving support surfaces) trial

Objective To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. Design Pragmatic, open, multicentre, randomised controlled trial. Setting 11 hospitals in six NHS trusts. Participants 1972 people admitted to hospital as acute or elective patients. Interventions Participants were randomised to an alternating pressure mattress (n = 982) of- an alternating pressure overlay (n = 990). Main outcome measures The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability Results Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7% overlay patients, 10.3% mattress patients; difference 0.4%, 95% confidence interval - 23% to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). Conclusion No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer

A Review on Pressure Ulcer: Aetiology, Cost, Detection and Prevention Systems

Pressure ulcer (also known as pressure sore, bedsore, ischemia, decubitus ulcer) is a global challenge for today’s healthcare society. Found in several locations in the human body such as the sacrum, heel, back of the head, shoulder, knee caps, it occurs when soft tissues are under continuous loading and a subject’s mobility is restricted (bedbound/chair bound). Blood flow in soft tissues becomes insufficient leading to tissue necrosis (cell death) and pressure ulcer. The subject’s physiological parameters (age, body mass index) and types of body support surface materials (mattress) are also factors in the formation of pressure ulcer. The economic impacts of these are huge, and the subject’s quality of life is reduced in many ways. There are several methods of detecting and preventing ulceration in human body. Detection depends on assessing local pressure on tissue and prevention on scales of risk used to assess a subject prior to admission. There are also various types of mattresses (air cushioned/liquid filled/foam) available to prevent ulceration. But, despite this work, pressure ulcers remain common.This article reviews the aetiology, cost, detection and prevention of these ulcers

Pressure Ulcer Prevention System

Pressure ulcers, also known as bedsores, are a widespread but often understated problem. A pressure ulcer is an injury that develops with constant pressure on an area of skin for a long time. They range from bruises to open wounds to even exposed bone. These injuries especially impact bedridden and elderly hospital inpatients, since these people must depend on nursing staff for mobility. Pressure ulcers can seem to be a solved problem. Solutions that completely eliminate pressure ulcers do exist. These solutions, however, are too expensive for widespread use, at thousands of dollars per bed. Other solutions, such as relying on nursing staff to move all patients is not reliable, and nurses develop chronic back pain from the strain of moving so many patients so often. The Pressure Ulcer Prevention System is designed specifically to be an affordable solution for these injuries in a hospital or assisted living setting. The system collects data from a gyroscopic sensor and multiple pressure sensors mounted on the patient, and sends an alert to the nurses’ station if a patient is at risk of developing a pressure ulcer, and needs attending. The system does not replace nurse care, nor does it change the most common solution of manually moving patients, but it instead helps nursing staff be more efficient

Personalized modeling for real-time pressure ulcer prevention in sitting posture

, Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily setup. Highlights-Buttocks biomechanical modelling,-Reduced order model,-Daily pressure ulcer prevention

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

Pressure ulcer related pain in community populations: a prevalence survey.

BACKGROUND: Pressure ulcers are costly to the healthcare provider and can have a major impact on patient's quality of life. One of the most distressing symptoms reported is pain. There is very little published data on the prevalence and details of pain experienced by patients with pressure ulcers, particularly in community populations. The study was conducted in two community NHS sites in the North of England. METHODS: The aim was to estimate the prevalence of pressure area related pain within a community population. We also explored the type and severity of the pain and its association with pressure ulcer classification. A cross-sectional survey was performed of community nurses caseloads to identify adult patients with pressure ulcers and associated pain. Consenting patients then had a full pain assessment and verification of pressure ulcer grade. RESULTS: A total of 287 patients were identified with pressure ulcers (0.51 per 1000 adult population). Of the 176 patients who were asked, 133 (75.6%) reported pain. 37 patients consented to a detailed pain assessment. Painful pressure ulcers of all grades and on nearly all body sites were identified. Pain intensity was not related to number or severity of pressure ulcer. Both inflammatory and neuropathic pain were reported at all body sites however the proportion of neuropathic pain was greater in pressure ulcers on lower limbs. CONCLUSIONS: This study has identified the extent and type of pain suffered by community patients with pressure ulcers and indicates the need for systematic and regular pain assessment and treatment