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

Influ?ncia do laser de alta pot?ncia na inibi??o de processos desmineralizadores do esmalte dental

Made available in DSpace on 2015-04-14T13:29:14Z (GMT). No. of bitstreams: 1 399354.pdf: 7916796 bytes, checksum: 52f9942a655db745c4d2a97dff7dead8 (MD5) Previous issue date: 2007-12-12Artigo 1 - Aim: The aim of this in vitro study was to investigate the effect of Nd:YAG and argon laser irradiations on the enamel acid demineralization by two different chemical laboratory models (pH cycling).Summary background data: The use of lasers to prevent enamel caries has been shown good results, but there are few comparative studies about the effect of different lasers in different pH models cycling.Methods and materials: Twenty one extracted human third molars were sectioned into tooth quarters. The quarters were distributed in three groups: GROUP I (control), non-treated; GROUP II received the Nd:YAG laser irradiation with the following protocol: 60 mJ, 15 pps, 0.9 W e 47.77 J/cm2, 30 seconds; and GROUP III received the argon laser irradiation with the following protocol: 250 mW, 12 J/cm2, 48 seconds. The surfaces were covered with an acid resistent varnish to be immersed in standard acidfied buffer solutions. The tooth quarters were submitted to a two different pH cycling: cycle 1: a 14-day remineralization (6 hours) and demineralization (18 hours) solutions, 37?C; cycle 2 with 48 hours in demineralization solution. The samples were prepared in slices (60 to 100 &#956;m) to be evaluated by polarized light microscopy. The demineralizations areas were measured (mm2) (n=11). Results: Means followed by different letters are significantly different to ANOVA and Tukey s test (p<0,05): 0.2509 A (control cycle 2); 0.1836 AB (control cycle 1); 0.1782 AB (Nd:YAG cycle 1); 0.1391 BC (argon cycle 2); 0.0927 BC (Nd:YAG cycle 2) e 0.0682 C (argon cycle 1). Conclusion:The results suggest that the treatment with argon laser was more effective, showing the smaller demineralization area by two different pH model cycling. Artigo 2 - Aim: The aim of this in vitro study was to investigate the effect of Nd:YAG and argon laser irradiations on the enamel acid demineralization by a chemical laboratory model to simulate acid erosion lesions.Summary background data: Erosive lesions in enamel are frequently found in patients with gastric-alimentary disturbs. There are no studies examining the use of lasers to prevent enamel erosions.Methods and materials: Third extracted human third molars were sectioned into tooth quarters. The quarters were distributed in three groups: GROUP I (control), non-treated; GROUP II received the Nd:YAG laser irradiation with the following protocol: 60 mJ, 15 pps, 0.9 W e 47.77 J/cm2, 30 seconds; and GROUP III received the argon laser irradiation with the following protocol: 250 mW, 12 J/cm2, 48 seconds. The surfaces were covered with an acid resistent varnish to be immersed in standard acidfied buffer solutions. The tooth quarters were submitted to a pH cycling: 14-day remineralization (6 hours) and demineralization (pH 2,5 - 18 hours) solutions, 37?C. The samples were prepared in slices (60 to 100 &#956;m) to be evaluated by polarized light microscopy. The demineralizations depths were mesured in mm (n=21). Results: Means followed by different letters are significantly different to ANOVA and Tukey s test (p<0,05): 0.1881 A (control occlusal); 0.1867 A (control cervical); 0.1610 B (argon occlusal); 0.1576 B (argon cervical); 0.1529 B (Nd:YAG occlusal); 0.1481 B (Nd:YAG cervical). Conclusions: The results suggest that the treatment with lasers increased the enamel acid demineralization resistance, so it can be indicated to prevent gastric-alimentary disturbs.Artigo 1 - Objetivo: O objetivo deste trabalho foi avaliar a ?rea de desmineraliza??o do esmalte irradiado com os lasers de Nd:YAG ou arg?nio, al?m de investigar dois m?todos de ciclagem de pH que simulam o desenvolvimento da doen?a c?rie.Problema: O uso dos lasers na preven??o de c?rie em esmalte tem sido pesquisado, mostrando bons resultados principalmente quando associados ao fl?or. Todavia, poucos estudos comparativos acerca do uso de lasers sobre o esmalte em diferentes ciclos de pH est?o dispon?veis.Materiais e m?todos: Vinte e um terceiros molares humanos inclusos extra?dos tiveram a por??o coron?ria seccionada em duas faces, vestibular e lingual; que, posteriormente, foram seccionadas em duas hemifaces. Os fragmentos foram distribu?dos aleatoriamente em tr?s grupos: o GRUPO I, de controle, n?o recebeu qualquer tratamento; o GRUPO II foi tratado com laser de Nd:YAG com 60 mJ, 15 pps, 0,9 W e 47,77 J/cm2, por 30 segundos; e, enfim, o GRUPO III tratado com laser de arg?nio com 250 mW, 12 J/cm2, por 48 segundos. Ap?s, as hemifaces de cada grupo tiveram a superf?cie de esmalte coberta com verniz, restando uma ?rea central de 3 mm x 3 mm, a qual foi exposta a um dos seguintes ciclos de pH: ciclo 1, compreendendo 14 dias de imers?o em solu??o desmineralizante por 6 horas/dia e solu??o remineralizante por 18 horas/dia a 37?C; ciclo 2, com 48 horas de imers?o em solu??o desmineralizante. As hemifaces foram cortadas em fatias com espessura de 60 a 100 &#956;m para obten??o das l?minas histol?gicas. Em seguida, foram observadas em microscopia de luz polarizada para medi??o das ?reas de desmineraliza??o (mm2) (n=11 por grupo). As m?dias obtidas foram: 0,2509 A (controle ciclo 2); 0,1836 AB (controle ciclo 1); 0,1782 AB (Nd:YAG ciclo 1); 0,1391 BC (arg?nio ciclo 2); 0,0927 BC (Nd:YAG ciclo 2) e 0,0682 C (arg?nio ciclo 1). M?dias seguidas de letras distintas apresentam diferen?a estat?stica para ANOVA e Tukey (p<0,05). Foi poss?vel concluir que o tratamento com o laser de arg?nio foi mais efetivo, apresentando uma menor ?rea de desmineraliza??o, sob a ciclagem de pH de 14 dias. Artigo 2 - Objetivo: O objetivo deste trabalho consistiu em avaliar a profundidade de desmineraliza??o do esmalte, nas paredes cervical e oclusal, ap?s a aplica??o dos lasers de Nd:YAG e arg?nio.Problema: Les?es erosivas s?o comuns em indiv?duos com dist?rbios gastro-alimentares e podem levar ? perda do esmalte dental. N?o h? relatos na literatura do uso de lasers como um tratamento preventivo desta situa??o cl?nica.Materiais e m?todos: Trinta terceiros molares extra?dos tiveram as coroas seccionadas em duas partes, vestibular e lingual; sendo cada face vestibular e cada face lingual seccionada no sentido oclusocervical, no centro da face, obtendo-se 4 hemifaces, as quais foram distribu?das em tr?s grupos: o, GRUPO I, de controle, que n?o recebeu qualquer tratamento; o GRUPO II, tratado com o laser de Nd:YAG com 60 mJ, 15 pps, 0,9 W e 47,77 J/cm2, por 30 segundos; e, enfim, o GRUPO III, tratado com o laser de arg?nio com 250 mW, 12 J/cm2, por 48 segundos. Ap?s a aplica??o dos lasers, os fragmentos foram submetidos ? ciclagem de pH 2,5 por 14 dias. Em seguida, foram obtidas l?minas histol?gicas de 60 a 100 &#956;m para serem observadas em microsc?pio ?ptico de luz polarizada (n=21 por grupo). A profundidade de desmineraliza??o foi mensurada (mm) e os resultados m?dios obtidos foram: 0,1881 A (controle oclusal); 0,1867 A (controle cervical); 0,1610 B (arg?nio oclusal); 0,1576 B (arg?nio cervical); 0,1529 B (Nd:YAG oclusal); 0,1481 B (Nd:YAG cervical). M?dias seguidas de letras distintas apresentam diferen?a estat?stica para ANOVA e Tukey (p<0,05). Foi poss?vel concluir que o tratamento com os lasers aumentou a resist?ncia do esmalte ao ?cido, podendo ser empregado como m?todo preventivo frente a dist?rbios gastro-alimentares. Al?m disso, n?o houve diferen?a na profundidade de desmineraliza??o do esmalte nas paredes cervical e oclusal

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