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 CONTENT OF CD4+ AND CD8+ EFFECTOR MEMORY CELLS AND THE PROLIFERATIVE ACTIVITY OF T LYMPHOCYTES IN BRONCHIAL ASTHMA

Bronchial asthma is a chronic inflammatory disease of the respiratory tract. T-lymphocytes play a key role in the pathogenesis of this allergic disease. The reduction in number of naive T cells and the accumulation of memory T cells in bronchial asthma are accompanied by dysregulation of T lymphocytes function. In present study, it was investigated the content of different subpopulations of T lymphocytes in the peripheral blood, in unstimulated and PHA-stimulated cultures, as well as their proliferative capacity in patients with bronchial asthma and healthy donors. The study included 10 patients with bronchial asthma (age 45.4 ± 11.8 years). One half of patients was in remission and the other half - in the stage of exacerbation of the underlying disease. The group of donors was formed by healthy individuals matched by gender and age to patients. Based on the expression of cell surface markers CD45R0, CD62L and CD197 (CCR7) CD4+ and CD8+ T lymphocytes were divided into central (Tcm) and effector memory cells (Tem), naive T-lymphocytes (Tnaive) and terminal-differentiated effectors (Temra) using flow cytometric technique. The proliferative activity of Tcm, Tem and Tnaive was evaluated in response to PHA as a functional marker of T cells. It was found that the percentage of CD4+TemCD62L+ and CD8+TemCD62L+ in the peripheral blood of patients in the exacerbation of asthma was significantly reduced compared to donors. After stimulation with PHA, these differences in T cell subsets between the groups of patients and donors were disappeared. We performed a correlation analysis between memory T cells and age . It was determined that the relative amount of CD4+ and CD8+ memory cells increased with age in asthmatics, but not in healthy donors. The analysis of mitogen-induced proliferation showed that Tcm and Tnaive cells divided more actively compared to other subpopulations in both groups. At the same time, the proliferative activity of CD4+ T lymphocytes and subsets of CD8+Tcm, CD4+Tcm and CD4+Tem62L- was higher in the group of patients in remission of asthma, than in groups of patients in exacerbation of the disease, and healthy donors. The revealed increase in the relative number of memory T cells with age suggests that these cells participate in the development of bronchial asthma. The proliferative response of the studied subpopulations, which was comparable with the donor values, indicates the retention of the functional characteristics of memory T cells and naive T lymphocytes in bronchial asthma. The increased proliferation of some T-cell subpopulations in asthmatics in remission points to the activated state of memory T cells. The observed decrease in the number of CD4+TemCD62L+ and CD8+TemCD62L+ in patients in exacerbation of asthma, by our opinion, may be associated with an active inflammatory process in the airways

Mechanochemically Obtained Phytobiotics Suppress the Development of Pathogens

Проведено исследование бактерицидного действия ряда фитопрепаратов, полученных в результате механохимической обработки смесей растительного сырья с твердым карбонатом натрия в отношении условно-патогенных бактерий Salmonella typhimurium, Shigella sonnei, Esherichia coli, Pasteurella multocida, Yersinia pseudotuberculosis, Streptococcu spyogenes, Staphylococcus aureus, Staphylococcu sepidermidis, Proteus vulgaris, Proteus mirabilis. Исследованные фитопрепараты характеризуются селективным воздействием на один – три вида микроорганизмов. Обнаружен эффект аддитивного действия фитопрепаратов в смеси, который может быть в дальнейшем использован вне смесей для профилактики и терапии конкретных случаев заболевания животных и человека с установленной бактериальной этиологиейA study of the bactericidal action of a number of phytopreparations obtained as a result of mechanochemical treatment of mixtures of plant raw materials with solid sodium carbonate in relation to 10 species of opportunistic bacteria was carried out. The investigated phytopreparations have a selective effect on 1-3 types of microorganisms. The effect of the additive action of phytopreparations in mixtures, which can be used for the prevention and treatment of diseases of animals and humans with an established bacterial etiology, has been discovere

Содержание нейроспецифических пептидов, маркеров нейромессенджера и нейрорецептора в сыворотке крови детей с вариативными сенсорными расстройствами, легкими когнитивными нарушениями и другой нейропатологией

Background. The role of recently discovered neurospecific peptides in the pathogenesis of acute and progressive neurologic disorders, their neuroprotective features, and possibilities to use them as markers for the course and prognosis of certain diseases have been actively studied in recent decades. However, neurospecific peptides are almost not studied in chronic residual diseases. In our study we measured the levels of neurospecific peptides and some other markers to achieve understanding of general neurophysiological trends in congenital and acquired chronic non-progressive brain pathology with reference to the selection of relevant groups — study objects. Objective. The aim of the study is to study patterns of neurospecific peptides, neurotransmitters and neuroreceptor markers distribution in the serum of children with various pathogenetic variants of chronic neuropathology. Methods. The study included children from 3 to 16 years old with different pathologies. The sample was divided into groups by pathology type: no sensory and neurological disorders, congenital sensory deficit due to mutation of genes expressed and not expressed in the brain, early acquired sensory deficit of multifactorial nature, congenital mild and severe organic disorders of central nervous system (CNS) in residual stage without baseline sensory deficit, acquired functional CNS disorders without baseline organic defect and sensory deficit. The following laboratory data (neurophysiological components) was studied: nerve growth factor, brain-derived neurotropic factor, neurotrophin-3, neurotrophin-4, neuregulin-1-beta-1, beta-secretase, sirtuin-1, synaptophysin, neuronal nitric oxide synthase, and anti-NR2 glutamate receptor antibodies. The parameters of cognitive activity, sense of vision, sense of smell, and acoustic sense were also evaluated. Results. The study included 274 participants. Neuropeptides and markers have shown a variable degree and range in the group spectrum of differences from normal levels. The most variable in the examined sample was NO-synthase, as well as levels of both neurotrophins, beta-secretase, and glutamate receptor marker. All visual deficits were associated with increased NO-synthase levels (p < 0.001). Neuroplasticity peptides (beta-secretase, neurotrophin-3 and 4) have been activated in all pathological conditions. Nerve growth factor and brain-derived neurotropic factor were specifically activated in mild organic CNS lesions (mild cognitive impairments), while neuregulin — in congenital genetically determined visual deficits. There was no specific activation of neuropeptides and NO-synthase level tended to decrease in cases of severe CNS lesions. Conclusion. The study results suggest that all types of early visual impairment are associated with increased physiological neuronal activity, and non-organic neurological functional disorders — mainly with increased physiological synaptic activity. General neuroplasticity processes were activated in all cases of visual deficits but more specific. However, more specific and well-studied processes were activated in mild organic CNS lesions, and neuroplasticity processes did not activate adequately in severe organic CNS lesions probably due to the limited neuronal and synaptic resources.Обоснование. В последние десятилетия активно исследуются вклад недавно открытых нейроспецифических пептидов в патогенез ряда острых и прогрессирующих заболеваний нервной системы, их нейропротективные свойства и возможности их использования для маркирования течения и прогноза некоторых заболеваний. При этом нейроспецифические пептиды почти не изучаются при хронических резидуальных состояниях. В нашем исследовании мы использовали определение уровней нейроспецифических пептидов и некоторых других маркеров для достижения понимания генеральных нейрофизиологических тенденций при врожденной и приобретенной хронической непрогрессирующей патологии мозга на основании подбора соответствующих групп — объектов исследования. Цель исследования — изучить закономерности распределения комплекса нейроспецифических пептидов, маркеров нейромессенджера и нейрорецептора в сыворотке крови детей с различными патогенетическими вариантами хронической нейропатологии. Методы. В исследование были включены дети с различной патологией в возрасте от 3 до 16 лет. Выборка была поделена на группы по типу патологии: отсутствие сенсорных и неврологических нарушений, врожденный сенсорный дефицит вследствие мутации генов, экспрессируемых и не экспрессируемых в мозге, рано приобретенный сенсорный дефицит полиэтиологической природы, врожденные легкие и тяжелые органические нарушения функций центральной нервной системы (ЦНС) в резидуальной стадии без исходного сенсорного дефицита, приобретенные функциональные расстройства ЦНС без исходного органического дефекта и сенсорного дефицита. В батарею измеряемых лабораторно в крови нейрофизиологических компонентов включили фактор роста нервов, нейротрофический фактор мозга, нейротрофин-3, нейротрофин-4, нейрегулин-1-бета-1, бета-секретазу, сиртуин-1, синаптофизин, нейрональную синтазу оксида азота и антитела к глутаматному рецептору NR2. Также оценивались параметры когнитивной деятельности, зрения, обоняния и слухового восприятия. Результаты. В исследование включены 274 участника. Установлено, что нейропептиды и маркеры показали вариативную степень и широту по групповому спектру отличий от нормы. Наиболее изменчивой в обследуемой выборке показала себя NO-синтаза, также часто различались уровни обоих нейротрофинов, бета-секретазы и маркера рецептора глутамата. При любых дефицитах зрения с большой достоверностью был повышен уровень NO-синтазы (р < 0,001). При всех патологических состояниях активировались пептиды нейропластичности — бета-секретаза, нейротрофины-3 и -4. При легких органических поражениях ЦНС (легкие когнитивные нарушения) специфично активировались фактор роста нервов и мозговой нейротрофический фактор, а при врожденных генетически детерминированных зрительных дефицитах специфично активировался нейрегулин. При тяжелых поражениях ЦНС специфической активации нейропептидов не определялось, а уровень NO-синтазы демонстрировал тенденцию к снижению по сравнению с нормой. Заключение. Результаты исследования позволяют предположить, что при всех типах раннего слабовидения происходит повышенная напряженность физиологической нейрональной деятельности, а при неорганических неврологических функциональных расстройствах — преимущественно повышение физиологической синаптической активности. При всех дефицитах зрения активированы процессы общей нейропластичности, но более специфические и изученные из них активируются при легких органических поражениях ЦНС, при тяжелых же органических поражениях ЦНС процессы нейропластичности недостаточно активны, вероятно, вследствие ограниченности нейрональных и синаптических ресурсов