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

bFGF decreased α-SMA and TGF-β1 expression in scars.

<p>Immunohistochemistry of the expression of (A) α-SMA and (B) TGF-β1 in scars treated with saline or bFGF in scars. (C) The levels of α-SMA and TGF-β1 in scars treated with saline or bFGF by Western blot. Analysis of the relative protein of (E) α-SMA and (F) TGF-β1 was performed. **<i>P</i><0.01 compared to control group.</p

bFGF alleviated the scar formation in rabbit ear model.

<p>(A) The averaged Epidermal Thickness Index (ETI) of the scars. Epidermal hypertrophy was displayed by ETI. ETI >1 depicts a hypertrophic epidermis. (B) The averaged scar elevation index (SEI) of the scars. Dermal hypertrophy is displayed by the SEI, where SEI >1 depicts a hypertrophic scar. *<i>P</i><0.05, **<i>P</i><0.01 compared to control group, n = 6. (C) The microscopic histology of wounds that control or bFGF at day 40, HE stain.</p

Wound closure and histopathological characteristics of bFGF treated wound healing in rat.

<p>(A) Representative photographs of full-thickness skin wounds at various time points after treatment with or without 1 µg/ml bFGF. (B) The wound healing rates of bFGF. *<i>P</i><0.05 compared to control group, n = 8. (C) Histopathological observation and masson staining of collagen in wound healing at day 14 post-wounding (×200).</p

The expression of PCNA, CD68 and TGF-β1 after bFGF treatment.

<p>Immunohistochemistry of (A) PCNA, (B) CD68 and (C) TGF-β1 was performed on the indicated day (×200); the histogram represents the positive cells and optical density of the immunohistochemistry results. *<i>P</i><0.05 and **<i>P</i><0.01 compared to control group, n = 8.</p

Primers used for real-time RT-PCR analysis.

<p>Primers used for real-time RT-PCR analysis.</p

bFGF decreased collagen I and collagen III synthesis.

<p>The levels of expression of (A) collagen Ι and (B) collagen III in scars treated with saline or bFGF, *<i>P</i><0.05, **<i>P</i><0.01 compared to control group, n = 6. (C) Immunohistochemistry of the expression of collagen III in scars treated with saline or bFGF (×200). (D) Analysis of relative density collagen III, *<i>P</i><0.05, **<i>P</i><0.01 compared to control group, n = 6.</p

Effects of bFGF on mRNA levels in HSF.

<p>RT-PCR analysis the mRNA levels of type collagen Ι and (B) collagen III, (C) CTGF, (D) HGF, (E) FN, (F) MMP-1, (G) TIMP-1, (H) SMAD-2, (I) SMAD-7, (J) α-SMA, (K) Lysine hydroxylases and (L) Prolyo hydroxylase in HSF treated with bFGF or saline for 5 days. *<i>P</i><0.05 compared to control group.</p