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

The original version of this article unfortunately contained a mistake

(Table 1) Radiocarbon datings and calendar year calibrations in sediment core MD99-2304, western Svalbard

A multi proxy sediment core record on the continental margin off western Svalbard, European Arctic, reflects large climatic and oceanographic oscillations at the Lateglacial-early Holocene transition. Based on studies of planktonic foraminifera, their stable oxygen and carbon isotopic composition and ice rafted debris, we have reconstructed the last 14 cal. ka BP. The period 14-13.5 cal. ka BP was characterized by highly unstable climatic conditions. Short-lived episodes of warming alternated with meltwater pulses and enhanced iceberg rafting. This period correlates to a regional warming of the northern North Atlantic. An overall decrease in meltwater took place during the deglaciation (14-10.8 cal. ka BP). The late Younger Dryas and subsequent transition into the early Holocene is characterized by a reduced flux of planktonic foraminifera and increased iceberg rafting. A major warming took place from 10.8 to 9.7 cal. ka BP, the influence of meltwater ceased and the flux of warm Atlantic Water increased. From 9.7 to 8.8 cal. ka BP, the western Svalbard margin surface waters were significantly warmer than today. This warm period, the thermal maximum, was followed by an abrupt cooling at 8.8. cal. ka BP, caused by an increased influence of Arctic Water from the Arctic Ocean. The results document that the European Arctic was very sensitive to climatic and oceanographic changes at the end of the last glacial and during the Holocene

Biogenic sedimentation on the northern Norwegian continental shelf

The relative proportions of marine organic carbon and biogenic carbonate in a high-resolution record from a glacial trough on the northern Norwegian continental shelf were used to decipher changes in biogenic sedimentation and paleoproductivity from the last deglaciation to the middle Holocene. Decadal-scale to century-scale oscillations in biogenic sedimentation and surface ocean productivity recorded in the Andfjorden sediments are synchronous with abrupt climate changes in open oceanic and atmospheric regimes of the high northern latitudes. Following several fluctuations during the Bølling-Allerød interstadial, the most dramatic drop in marine organic carbon and biogenic carbonate proportions occurred during the Younger Dryas. However, many short-term and low-amplitude events during the Preboreal and the Holocene have also affected biogenic sedimentation in the outer Andfjorden. Apparently, these abrupt changes in biogenic sedimentation were caused by the suppression of a potential upwelling center in the outer Andfjorden by variable Atlantic Water inflow over the past 14,000 years. The adjustment of decadal high-productivity coastal systems to freshwater-forced multiple cooling events during the late glacial to middle Holocene highlights the impact of global climate changes on the climate-sensitive local ecosystems off coastal Norway

Multiple-stage deglacial retreat of the southern Greenland Ice Sheet linked with Irminger current warm water transport

International audienceThere is limited knowledge pertaining to the history of the Greenland Ice Sheet (GIS) during the last glacial‐interglacial transition as it retreated from the continental margins to an inland position. Here we use multiproxy data, including ice‐rafted debris (IRD); planktonic isotopes; alkenone temperatures; and tephra geochemistry from the northern Labrador Sea, off southwest Greenland, to investigate the deglacial response of the GIS and evaluate its implications for the North Atlantic deglacial development. The results imply that the southern GIS retreated in three successive stages: (1) early deglaciation of the East Greenland margins, by tephra‐rich IRD that embrace Heinrich Event 1; (2) progressive retreat during Allerød culminating in major meltwater releases (δ18O depletion of 1.2‰) at the Allerød–Younger Dryas transition (12.8–13.0 kyr B.P.); and (3) a final stage of glacial recession during the early Holocene (∼9–11 kyr B.P.). Rather than indicating local temperatures of ambient surface water, the alkenones likely were transported to the core site by the Irminger Current. We attribute the timing of GIS retreat to the incursion of warm intermediate waters along the base of grounded glaciers and below floating ice shelves on the continental margin. The results lend support to the view that GIS meltwater presented a forcing factor for the Younger Dryas cooling