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

Gastrenterite eosinofílica

A gastrenterite eosinofílica é uma doença rara, caracterizada pela presença de infiltrado inflamatório eosinofílico em, pelo menos, um segmento do aparelho digestivo. A apresentação clínica é heterogénea, dependendo da localização, extensão e profundidade do processo inflamatório na parede do tubo digestivo. Pode haver associação com alergias e eosinofilia periférica. Os achados imagiológicos e endoscópicos são variáveis e inespecíficos, contribuindo somente para apoiar o diagnóstico. O tratamento da gastrenterite eosinofílica assenta fundamentalmente na corticoterapia. O prognóstico é globalmente favorável, sem risco acrescido de neoplasia gastrintestinal. Eosinophilic gastroenteritis is a rare disorder, characterized by eosinophilic infiltration of any part of the gastrointestinal tract. Clinical presentation is heterogeneous, depending on the site, length and depth of inflammation in the intestinal wall. Allergies and peripheral eosinophilia may be present. Radiographic and endoscopic findings are variable, nonspecific and only contribute to support the diagnosis. Corticosteroids are the mainstay of therapy. Prognosis is good and there is no increased risk of gastrointestinal malignancy

Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer

BACKGROUND/AIM: Progressive dysphagia is the most important symptom in inoperable cases of carcinoma of the esophagus and cardia. Treatment for the relief of dysphagia is chosen based on the lowest mortality and morbidity. This paper describes alpha consecutive series of patients with esophageal or cardial cancer, without a documented tracheoesophageal fistula, who were referred for palliative laser therapy. Alternative palliative treatments are discussed, as well as factors involved in successful laser treatment. MATERIAL AND METHODS: Over a five year period, 104 patients were treated endoscopically with the Nd-YAG laser for symptomatic improvement dysphagia caused by malignant tumors of the esophagus or cardia. RESULTS: After the initial laser therapy, good improvement was achieved in 78 patients (75%) and fair improvement in 17 patients (16%). Eighty-three patients with significant improvement were followed until death. In 42 of these 83 patients, the initial laser therapy was the only treatment given; the remaining 41 patients required either additional laser treatment or other palliative therapy. CONCLUSION: Laser treatment for palliation in esophageal and cardial cancer is promising. Given the proper circumstances, it may lay the framework for many other important treatment modalities

Hepatotoxicidade por Nimesulide: a propósito de um caso clínico

A case of a forty-four years old rural female admitted due to vaginal discharge and inguinal lymphadenopathies is presented. She took nimesulide and, after two days, started with constitutional symptoms. At hospital admission she presented with jaundice, conjunctival suffusion and pharyngeal injection. Blood tests revealed cytopenia, marked hepatic citolysis, cholestasis, renal failure and reactive C protein elevation. Complementary studies showed positive antinuclear autoantibodies, mild elevation of immunoglobulins M and E, and a thickened gallbladder wall. Lymphocyte transformation test was positive for nimesulide. There was a clinical and laboratorial improvement after cessation of the drug. The authors discuss the main diagnostic hypotheses enfatizing definition criteria for hepatotoxicity and also the difficulty in establishing this diagnosis

Oesophageal lichen planus

Lichen planus is a common skin and mucosal disease, with very rare symptomatic oesophageal involvement. We report a case of painful dysphagia due to oesophageal lichen planus in a 60-year-old woman who also had oral, cutaneous and genital lichen planus lesions. Steroid treatment produced considerable improvement of all lesions and a rapid symptomatic remission