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

The use of continuous Flow Ventilatory Support for Hypercapnic Respiratory Failure

Our aim was to assess the effectivity of continuous flow ventilatory support (CFVS) in those COPD patients undergoing cardiac surgery who developed hypercapnic respiratory failure.Materials and methods. CFVS was applied in 11 COPD (Stage 2.55±0.52 on average) patients undergoing cardiac surgery, after weaning from «conventional» pressure controlled (PCV) or pressure support ventilation (PSV) mode. All of these patients had hypercapnea with respiratory failure that has been manifested after 15±10 hours after postoperative weaning from ventilator. CFVS was applied using nasotracheal catheter (diameter 5–6 mm) with average inspiratory flow Qin = 26±2,3 l/min while using FiO2 of 0.3–0.35.Results. Only one out of 11 patients failed to recover from hypercapnic respiratory failure using CFVS and had to be intubated instead. Spontaneous ventilation frequency was gradually decreasing from 24.8±3.6 breaths/min to 16±2 breaths/min after initiation of CFVS (P<0.01). Average value of PaO2 before CFVS was 59±7.5 mmHg and rose to 99.6±4.5 mmHg just before CFVS was terminated (P<0.01). PaCO2 before CFVS was measured to be 73.2±7.5 mmHg and dropped to 45.7±4.3 mmHg (P<0.01). CO2 drop was fast in the first 18 hours from CFVS application. Average time for application of CFVS was 3.09±0.9 day.Conclusion. CFVS is an effective and minimally invasive mode of ventilation support that can be used in patients suffering from hypercapnic respiratory failure to avoid the need to intubate trachea and connect the patient to conventional ventilator

Management of hypotension after general anaesthesia induction - multicenter questionnaire study

Cíl studie: Cílem naší práce bylo posouzení variability terapie hypotenze po úvodu do celkové anestezie (GAIH). Typ studie: Multicentrická dotazníková studie. Typ pracovišť: Osm anesteziologických pracovišť různé velikosti z České a Slovenské republiky. Materiál a metoda: Respondenti odpovídali na tři identifikační otázky (pracoviště, délka praxe, specializovaná způsobilost) a deset zjišťovacích otázek týkajících se managementu GAIH v online dotazníku. Byla použita jednoduchá popisná statistika hodnotící zastoupení odpovědí respondentů v absolutních a relativních četnostech. Normalizovaná entropie (H) byla použita k posouzení variability odpovědí. Výsledky: Plně vyplněný dotazník jsme získali od 172 respondentů. Největší míra variability byla pozorována u otázky č. 1.: „Za referenční hodnotu tlaku krve, se kterou porovnávám další hodnoty..., považuji…“ (H = 0,966). Nejnižší míra variability odpovědí byla zaznamenána u otázky č. 4.: „Za hypotenzi považuji pokles…“ (H = 0,070). Závěr: Výsledky práce ukazují vysokou variabilitu názorů na terapii GAIH.Objective: The aim of our study was to assess the management of hypotension after general anaesthesia induction (GAIH). Design: Multicenter questionnaire study. Setting: Eight different size anaesthesiology departments located in the Czech or Slovak Republics. Materials and methods: The respondents responded to three identification questions (workplace, length of practince) and ten GAIH management questions in our online questionnaire. Simple descriptive statistics describing the representation of the respondents' answers in absolute and relative terms were used. Normalized entropy (H) was used to assess the variability of responses. Results: A fully completed questionnaire was obtained from 172 respondents. The highest rate of variability was observed in question 1.: "As the baseline blood pressure value (BP), to which I compare other BP values, I consider..." H = 0.966. The lowest response variability rate was observed in question 4.: "As hypotension, I consider the Of BP..." H = 0.07). Conclusion: Our results indicate high variability of GAIH management among anaesthetists.Web of Science303-412511