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

High-temperature oxidation of Fe-Si alloys in the temperature range 900-1250 degrees C

Exposure of metals and alloys to high temperatures leads to the formation of oxide scales, with a large impact on surface quality. The most important features of the oxide layer are its thickness, composition, structure, adherence and coherence. Temperature, time, gas atmosphere and chemical composition determine the growth of oxide layers. In this paper, the characteristics of the high temperature oxidation properties of Fe-Si alloys are discussed in terms of oxide growth mechanism, kinetics and phase morphology. The oxidation kinetics of different Fe-Si alloy steels in air, its scale structure and composition were investigated over the temperature range 900-1250 degrees C. Oxidation experiments were performed in air, to analyse the oxidation process. Experiments were carried out in an electric furnace at temperatures ranging from 900 to 1250 degrees C, for times between 16 and 7200s. Thus treated specimens were characterised by metallography and their scale thickness was measured by optical microscopy. Scale morphology was studied and scale composition confirmed by EDS (Energy Dispersive Spectroscopy) and EBSD (Electron Backscattered Diffraction) analysis. Results show that high temperature oxidation of Si-alloys presents the classic three layered oxide scale. On the grain boundaries in the scale, iron-silicate was found. Observations show a Si-enrichment at the scale -metal interface. This enrichment is present in the form a mixed wustite-iron silicate (fayalite) phase, FeO-Fe2SiO4. A very rapid build-up of oxide occurs when a liquid phase, due to the wustite-fayalite eutectic, is present in the surface of the steel

Effect of Si on high-temperature oxidation of steel during hot rolling

An oxide scale layer always forms at the strip surface during the hot rolling process. As a consequence, de-scaling and pickling operations must be performed prior or after hot rolling. Many surface defects caused by hot rolling are related to oxidation in the reheating furnace. One of these is the melting of eutectic FeO/Fe2SiO4 during reheating over 1170 degrees C giving as a result red scale defects in Si-added steel. On the other hand, steel strip surface oxidation during hot rolling causes an industrial and environmental problem: secondary oxide is removed after roughing, but tertiary oxide scales already start to form before entering the finishing stands. Their properties affect the final steel surface quality and its response to further processing. Furthermore, the addition of alloying elements has an important impact on scale properties. In particular the alloying of silicon effects the region between scale and substrate. It causes peculiar surface properties inherited from its specific oxidation characteristics. Conventional oxidation experiments in air of silicon steels are a valuable too] to study the influence of Si on steel oxidation. After oxidation in air in the temperature range of 900-1250 degrees C it has been observed that Si enhance markedly scale adhesion, especially above 1177 degrees C (the eutectic temperature of FeO-Fe2SiO4) and also at lower temperatures. Special attention has been paid on the investigation of the effects of alloying Si on the high-temperature oxidation of steel, for a better understanding of the behaviour of modem steels during hot rolling

Temperature evolution during plane strain compression of tertiary oxide scale on steel

An oxide scale layer always forms at the steel surface during hot rolling. This scale layer separates the work roll from the metal substrate. Understanding the deformation behaviour and mechanical properties of the scale is of great interest because it affects the frictional conditions during hot rolling and the heat-transfer behaviour at the strip-roll interface. A thin wustite scale layer (< 20 mu m) was created tinder controlled conditions in an original laboratory device adequately positioned in a compression testing machine to investigate plane strain compression. Oxidation tests were performed on an ULC steel grade. After the oxide growth at 1050 degrees C, plane strain compression (PSC) was performed immediately to simulate the hot rolling process. PSC experiments were performed at a deformation temperature of 1050 degrees C, with reduction ratios front 5 to 70%, and strain rates of 10s(-1) under controlled gas atmospheres. Results show that for wustite, ductility is obvious at 1050 degrees C. Even after deformation oxide layers exhibit good adhesion to the substrate and homogeneity over the thickness. The tool/sample temperature difference seems to be the reason for the unexpected ductile behaviour of the scale layer

Effects of Mg additions on surface morphology and corrosion resistance of hot-dipped Zn coatings

Steel is still the main construction material for automobiles, general equipment and industrial machinery. Hot dipping has been proven to be an excellent method of corrosion protection of steels for a wide range of applications worldwide. Coatings of Zn-Al alloys on steel sheet have high corrosion resistance due to the corrosion prevention ability from Zn and the passivation of Al Bath composition, immersion velocity/time and substrate composition are the hot dipping parameters that more influence on the thickness and corrosion resistance of the deposited coating. In order to study their influence small amounts of magnesium were added. Experiments were performed in a hot dipping simulator using different substrates, bath compositions and hot dipping parameters. Surface layers were characterised by: Scanning Electron Microscopy (SEM) and Energy dispersive X-Ray spectroscopy (EDX or EDS). Cyclic corrosion tests were performed in order to observe the corrosion resistance for different Zn-Al-Mg coatings. Results show that the microstructure and composition of the substrate strongly affect the desired coating properties. Nevertheless, the influence of the magnesium on coating thickness is relevant, increasing when added in small quantities in a molten bath of Zn-5wt %Al. The quality and microstructure of the coating is affected by the amount of Mg in the bath. Cyclic corrosion tests results show that the quality of the coating is affected by the amount of Mg in the bath

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