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

A organização da política de saúde da pessoa com deficiência no estado do Paraná (The organization of the politics of health of the person with deficiency in the state of Paraná) Doi: 10.5212/Emancipacao.v.13i2.0001

O presente artigo discute a política de saúde da pessoa com deficiência, com ênfase na sua organização no estado e municípios do Paraná. Para compreensão do tema, num primeiro momento apresentamos uma breve discussão sobre a saúde enquanto um direito constitucional. Logo após, discutimos os conceitos sobre deficiência e apresentamos os dados estatísticos visando compreender a realidade brasileira. Por fim, demonstramos como a política nas três esferas de governo está definida e organizada e apresentamos as considerações finais. Podemos concluir que houve um avanço na definição do modelo de política a ser implementada pelos municípios do Paraná, entretanto a garantia do acesso está diretamente relacionada ao cumprimento das determinações legais. Palavras-chave: Saúde. Pessoa com deficiência.     Abstract: The present study discusses the politics of health of the person with deficiency, with emphasis in its organization in the state and cities of Paraná. For understanding the subject, at the first moment we present one brief argument on health as a constitutional right. Next, we argue the concepts on deficiency and present the statistical data aiming to understand the Brazilian reality. Lastly, we demonstrate how the politics in the three spheres of government are defined and organized and we present our fi nal considerations. We can conclude that it had an advance in the definition of the politics model to be implemented by the cities of Paraná, however, the guarantee of the access is directly related to the fulfillment of the legal determinations. Keywords: Health. Handicapped person. </p

Tendências atuais da proteção social: considerações sobre o workfare e as políticas de ativação

In our society, institutional social protection is undoubtedly necessary to face the expressions of the “social issue”. After an exceptional period of unparalleled success, canonized in European Social State models, social rights are blatantly the target of capital offensives. Through a bibliographic review pertinent to the theme, this article aims to understand the consequences of this panorama for social protection and the trends for its implementation in the context of the crisis of capitalism, high unemployment rates and retraction of State responsibilities; trends embodied in workfare measures and activation policies, already present in European and American social contexts. The study shows that several governments in the developed world defend these guidelines under the justification of maintaining the social protection system and full social integration of individuals when, in fact, these measures bring the penalization of subjects for the consequences inherent to the expansion of capitalism.En nuestra sociedad, la protección social institucional es sin duda necesaria para enfrentar las expresiones de la “cuestión social”. Después de un período excepcional de éxito sin precedentes, canonizado en los modelos de Estado social europeo, los derechos sociales son el blanco flagrante de las ofensivas capitales. A través de una revisión bibliográfica pertinente a la temática, este artículo busca comprender las consecuencias de este panorama para la protección social y las tendencias para su implementación en el contexto de la crisis del capitalismo, altas tasas de desempleo y retracción de responsabilidades del Estado; tendencias plasmadas en medidas de workfare y políticas de activación, ya presentes en los contextos sociales europeos y americanos. El estudio muestra que varios gobiernos del mundo desarrollado defienden estas orientaciones bajo la justificación del mantenimiento del sistema de protección social y la plena integración social de los individuos cuando, de hecho, estas medidas conllevan la penalización de los sujetos por las consecuencias inherentes a la expansión del capitalismo.          Em nossa sociedade, a proteção social institucional se coloca como incontestavelmente necessária ao enfretamento das expressões da “questão social”. Após um período excepcional de êxito inigualável, canonizado nos modelos de Estado Social Europeus, os direitos sociais são flagrantemente alvo de ofensivas do capital. Através de revisão bibliográfica pertinente ao tema, esse artigo objetiva entender as consequências desse panorama para a proteção social e as tendências para sua efetivação em contexto de crise do capitalismo, de altos índices de desemprego e retração das responsabilidades do Estado; tendências consubstanciadas nas medidas de workfare e nas políticas de ativação, já presentes nos contextos sociais europeu e estadunidense. O estudo evidencia que vários governos do mundo desenvolvido defendem essas orientações sob a justificativa de manutenção do sistema de proteção social e plena integração social dos indivíduos quando, de fato, essas medidas trazem a penalização dos sujeitos pelas consequências inerentes à expansão do capitalismo

O Serviço Social e a Reprodução das Relações Sociais

O Serviço Social atua como partícipe da reprodução das contraditórias relações sociais. Portanto, para além do seu papel na manutenção da sociedade capitalista, converge possibilidades para contemplar interesses dos trabalhadores. Como condição para tal efetivação, faz-se necessária a compreensão desse caráter ambíguo da profissão, entendendo sua emersão e sua inserção na realidade social, devendo essa ser apreendida sob o aspecto da totalidade. Este artigo, por meio de revisão de literatura, resgata a teoria marxiana sobre a produção e reprodução da vida social e particulariza o papel do Serviço Social inserido nesse processo

A organização da política de saúde da pessoa com deficiência no estado do Paraná

The present study discusses the politics of health of the person with deficiency, with emphasis in its organization in the state and cities of Paraná. For understanding the subject, at the first moment we present one brief argument on health as a constitutional right. Next, we argue the concepts on deficiency and present the statistical data aiming to understand the Brazilian reality. Lastly, we demonstrate how the politics in the three spheres of government are defined and organized and we present our fi nal considerations. We can conclude that it had an advance in the definition of the politics model to be implemented by the cities of Paraná, however, the guarantee of the access is directly related to the fulfillment of the legal determinations.O presente artigo discute a política de saúde da pessoa com deficiência, com ênfase na sua organização no estado e municípios do Paraná. Para compreensão do tema, num primeiro momento apresentamos uma breve discussão sobre a saúde enquanto um direito constitucional. Logo após, discutimos os conceitos sobre deficiência e apresentamos os dados estatísticos visando compreender a realidade brasileira. Por fim, demonstramos como a política nas três esferas de governo está definida e organizada e apresentamos as considerações finais. Podemos concluir que houve um avanço na definição do modelo de política a ser implementada pelos municípios do Paraná, entretanto a garantia do acesso está diretamente relacionada ao cumprimento das determinações legais.

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status