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

Bi-functional biobased packing of the cassava starch, glycerol, licuri nanocellulose and red propolis.

The aim of this study was to characterize and determine the bi-functional efficacy of active packaging films produced with starch (4%) and glycerol (1.0%), reinforced with cellulose nanocrystals (0-1%) and activated with alcoholic extracts of red propolis (0.4 to 1.0%). The cellulose nanocrystals used in this study were extracted from licuri leaves. The films were characterized using moisture, water-activity analyses and water vapor-permeability tests and were tested regarding their total phenolic compounds and mechanical properties. The antimicrobial and antioxidant efficacy of the films were evaluated by monitoring the use of the active films for packaging cheese curds and butter, respectively. The cellulose nanocrystals increased the mechanical strength of the films and reduced the water permeability and water activity. The active film had an antimicrobial effect on coagulase-positive staphylococci in cheese curds and reduced the oxidation of butter during storage

Caracterização e avaliação das propriedades antioxidantes de filmes biodegradáveis incorporados com polpas de frutas tropicais

O trabalho teve como objetivo desenvolver e caracterizar embalagens ativas flexíveis formuladas pela incorporação de polpas de frutas tropicais a uma matriz polimérica de amido de mandioca plastificada com glicerol, avaliando as propriedades mecânicas, de barreira e a eficácia antioxidante destas embalagens durante o armazenamento. As embalagens foram produzidas por casting, com concentrações fixas de amido de mandioca (4,5%) e glicerol (1,0%), e concentrações de polpa de manga, acerola e seriguela entre 5 e 20%. Foram caracterizadas as propriedades de barreira (espessura, umidade, sólidos totais, atividade de água e solubilidade) e propriedades mecânicas dos filmes. A ação antioxidante dos aditivos incorporados foi avaliada através do armazenamento do azeite de dendê embalado com os filmes contendo os aditivos naturais, monitorando a sua oxidação por 40 dias, sob condições de oxidação acelerada (63%UR/30°C). A adição das polpas de frutas aos filmes promoveu um aumento da resistência mecânica. Os filmes com as polpas incorporadas desempenharam efeito antioxidante sobre o azeite de dendê durante os 40 dias de armazenamento, podendo ser aplicados para o controle da oxidação deste produto

TEM image of licuri cellulose nanocrystals (CNC_s).

<p>TEM image of licuri cellulose nanocrystals (CNC_s).</p

Effect Antimicrobial and antioxidant of active film during products storage.

<p>Means with the same letters in the same columns presented no statistical difference (p>0.05) according to Tukey’s test.</p><p>C1 = film without propolis; C2 = film of low-density polyethylene; C3 = product without any package; F9 = active film (starch, glycerol and 0.5% licuri cellulose nanocrystals).</p><p>Effect Antimicrobial and antioxidant of active film during products storage.</p

Pareto graph (A) and response surface (B) generated between CNCs, Total Phenolic and ERP.

<p>Pareto graph (A) and response surface (B) generated between CNCs, Total Phenolic and ERP.</p

Properties of the films formulations with different contents of ERP and CNCs.

a<p><i>central points;</i> C0 = cassava starch films without propolis and cellulose nanocrystals<b><i>;</i></b> C1 = cassava starch films without propolis; C2 = polyethylene film <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112554#pone.0112554-Coutinho1" target="_blank">[35]</a>; Aw = water activity; M = moisture; TPC = total phenolic compounds; WVP = water vapor permeability; <i>E</i> = elastic modulus; σ = tensile strength; ε = elongation at break; ERP = extract of the red propolis; CNCs = <i>licuri</i> cellulose nanocrystals.</p><p>Properties of the films formulations with different contents of ERP and CNCs.</p