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

Un autre regard : enjeux de la participation infirmière durant les décisions de limitations et d'arrêts de traitements en réanimation

End-of-life decision-making in the Intensive Care Units (I.C.U.) is often a source of dissatisfaction, moral distress & conflict among critical care workers. In this work, we focused on the French legal concept of “collegial procedure”, which is supposed to apply to end of life decision making and requires nurses participation. First, we studied the decisional processes and found they followed 5 steps : 1) Triggers for questioning the ongoing project, 2) Shared questioning, 3) Organization of a team meeting, 4) Informing the patient & his/her relatives, & 5) implementation of the final decision. We focused on variations for each of these steps and tried to understand barriers to a fruitful & satisfying collaborativeness. In a second part of this work, we tried to understand the specificities nurses may add to those end-of-life decision-making processes. We found that nurses are experts on the patient’s body & lived body (how does she/he inhabits her/his body in health but when dealing with illness). We used J.Lawler concept of somology. The third part of this work deals with the narrative work ICU caregivers manage around their unconscious patients, especially in the context of changes in the therapeutic project. This PhD thesis, hopefully, focuses on three aspects of a classical topic that are seldomly studied and provide new tools to think and improve overall satisfaction around end of life decision-making.Les prises de décision de limitations et d’arrêts des traitements chez les patients de réanimation suscitent encore de nombreuses insatisfactions au sein des équipes de soin, et ces insatisfactions sont source de détresse morale et de conflits. Nous nous sommes donc intéressés à la mise en œuvre de la « procédure collégiale » dans les services de réanimation français. Dans un premier temps, nous avons étudié en détail les processus décisionnels et avons découvert qu’ils suivaient 5 étapes : 1) Le déclenchement, 2) La divulgation, 3) La réunion pluri-professionnelle, 4) L’information des proches (et des patients le cas échéant), et 5) La mise en œuvre des L.A.T. Nous nous sommes attachés à mettre au jour les variations existantes pour chaque étape ainsi qu’à comprendre les obstacles à la collégialité et à la satisfaction des médecins et des infirmiers. Dans un deuxième temps, nous avons cherché à déterminer les spécificités du regard infirmier sur les situations déclenchant une procédure collégiale. Il nous est apparu que l’expertise spécifique infirmière porte sur la connaissance du corps et du vécu du corps du patient (corps en santé, corps soumis à la maladie). Nous avons repris le concept de J. Lawler de savoirs somologiques. Dans un troisième temps, nous nous sommes intéressés au travail narratif des soignants en réanimation autour des patients inconscients, et plus spécifiquement dans le contexte des modifications de projet thérapeutique. Ce travail de thèse, nous l’espérons, présente ainsi trois aspects peu étudiés d’un sujet pourtant classique et apporte de nouveaux outils pour penser les insatisfactions autour des décisions de L.A.T

A different look : how nurses are involved in end-of-life decision-making processes in France and what do they really add to the table?

Les prises de décision de limitations et d’arrêts des traitements chez les patients de réanimation suscitent encore de nombreuses insatisfactions au sein des équipes de soin, et ces insatisfactions sont source de détresse morale et de conflits. Nous nous sommes donc intéressés à la mise en œuvre de la « procédure collégiale » dans les services de réanimation français. Dans un premier temps, nous avons étudié en détail les processus décisionnels et avons découvert qu’ils suivaient 5 étapes : 1) Le déclenchement, 2) La divulgation, 3) La réunion pluri-professionnelle, 4) L’information des proches (et des patients le cas échéant), et 5) La mise en œuvre des L.A.T. Nous nous sommes attachés à mettre au jour les variations existantes pour chaque étape ainsi qu’à comprendre les obstacles à la collégialité et à la satisfaction des médecins et des infirmiers. Dans un deuxième temps, nous avons cherché à déterminer les spécificités du regard infirmier sur les situations déclenchant une procédure collégiale. Il nous est apparu que l’expertise spécifique infirmière porte sur la connaissance du corps et du vécu du corps du patient (corps en santé, corps soumis à la maladie). Nous avons repris le concept de J. Lawler de savoirs somologiques. Dans un troisième temps, nous nous sommes intéressés au travail narratif des soignants en réanimation autour des patients inconscients, et plus spécifiquement dans le contexte des modifications de projet thérapeutique. Ce travail de thèse, nous l’espérons, présente ainsi trois aspects peu étudiés d’un sujet pourtant classique et apporte de nouveaux outils pour penser les insatisfactions autour des décisions de L.A.T.End-of-life decision-making in the Intensive Care Units (I.C.U.) is often a source of dissatisfaction, moral distress & conflict among critical care workers. In this work, we focused on the French legal concept of “collegial procedure”, which is supposed to apply to end of life decision making and requires nurses participation. First, we studied the decisional processes and found they followed 5 steps : 1) Triggers for questioning the ongoing project, 2) Shared questioning, 3) Organization of a team meeting, 4) Informing the patient & his/her relatives, & 5) implementation of the final decision. We focused on variations for each of these steps and tried to understand barriers to a fruitful & satisfying collaborativeness. In a second part of this work, we tried to understand the specificities nurses may add to those end-of-life decision-making processes. We found that nurses are experts on the patient’s body & lived body (how does she/he inhabits her/his body in health but when dealing with illness). We used J.Lawler concept of somology. The third part of this work deals with the narrative work ICU caregivers manage around their unconscious patients, especially in the context of changes in the therapeutic project. This PhD thesis, hopefully, focuses on three aspects of a classical topic that are seldomly studied and provide new tools to think and improve overall satisfaction around end of life decision-making

An Interprofessional Process for the Limitation of Life-Sustaining Treatments at the End of Life in France

International audienceContext: The provision of potentially non-beneficial life-sustaining treatments (LSTs) remains a challenging problem. In 2005, legislation in France established an interprofessional process by which non-beneficial LSTs could be withheld or withdrawn, permitting exploration of the effects of such a legally-protected process and its implementation. Objectives: To characterize intensive care unit (ICU) interprofessional team decision-making and consensus-building practices regarding withholding and withdrawing of LSTs in two Parisian hospitals and to explore physician and nurse perceptions of and experiences with these practices. Methods: This was an exploratory qualitative study utilizing thematic analysis of semi-structured, in-depth interviews of physicians and nurses purposively sampled based on level of training and experience from two hospitals in Paris, France. Results: A total of 25 participants were interviewed. Participants reported that the two Parisian hospitals in this study have each created an interprofessional process for withholding or withdrawing non-beneficial LSTs, providing insight into how norms of decision-making respond to systems-level legal changes. Participants reported that these processes tended to be consistent across several domains: maintaining unified messaging with patients, empowering nurses to participate in end-of-life decision-making, reducing moral distress provoked by end-of-life decisions, and shaping the ethical milieu within which end-of-life decision-making takes place. Conclusions: The architecture of the interprofessional process created at two Parisian hospitals and its perceived benefits may be useful to clinicians and policy-makers attempting to establish processes, policies, or legislation directed at withholding or withdrawing potentially non-beneficial LSTs in the United States and elsewhere

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

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 (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected