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

Τρισδιάστατη κυκλοφορία, επίδραση της επίγειας φόρτισης και των ατμοσφαιρικών συνθηκών σε εποχιακή και κλιματική χρονική κλίμακα στην Ανατολική Μεσογείο: η περιπτωσιολογική μελέτη του Κόλπου Καλλονής, Λέσβος, Ελλάδα

PREFACE: In order to investigate the various issues raised in the present study, a number of objectives were defined and approached in different chapters. The framework starts with a synoptic scale approach studying the in situ data, continues raising the scale to seasonal study and in the last chapter the study focuses in larger scale with the study of the response of the ecosystem to climate change. The climate trends for the study area established, and a water budget model applied aiming to highlight the impact of the climate trends to the ecosystem of the Kalloni gulf. The 1st Chapter is focusing on the Aegean Sea where the study area is located. The climate trends and the climate indices that already had been established in the global bibliography for the Aegean were presented; while the impacts that already are visible in the Aegean regions, especially along the coast, are reported. In addition the circulation of the Aegean Sea is presented from various papers that had been carried out for the basin. In Chapter 2 an overview that focuses on the Mediterranean coastal lagoons was made. The characteristic of the coastal lagoons as well as their role and their importance as ecosystems were analyzed. The anthropogenic pressure as a major factor in the sensitivity of the marine ecosystem was approached. The unique functioning of the lagoons was reviewed; while the hot spot of the response of the marine ecosystem to the climate change was analyzed according to exits studies. Finally the state of the art – the knowledge for the study area was conducted in a detailed overview from the first study in 1980 until nowadays. Chapter 3 refers to the aims and the objectives of the present framework; while some general information about the strategy that was followed for the conducting of the research is given. Chapter 4 is targeted to the observational methodology that was followed. At the begging the characteristics of the study area (Kalloni Gulf) are given analytically. Thereafter the field work and the data processing as well as the method that was used for the first analyzes are discussed.5th Chapter continues with the observational approach, emerging the seasonal fluctuations and provides the description of the ecosystem. Climatological data was compiled while time series for the wind forcing was studied further. The chemical parameters were analyzed and valuable information for the ecosystem was revealed. The physical parameters studied in detailed, aims to understand and emerge the hydrodynamic structure of the gulf with the observational method. Finally two different patterns were emerged, showing the 2D circulation pattern of the gulf. In Chapter 6 the numerical approach established, pointing to reveal whatever was overlooked with the first method. Although the observational method gives valuable results for the hydrodynamic structure of the gulf, basic characteristics led to the question ‘’if in reality the circulation isn’t 2D but 3D’’ and to the possibility to have been overlooked with the specific approach. The 3D hydrodynamic Princeton Ocean Model (POM) applied for the Kalloni gulf and the entire methodology is explained in the present chapter. Chapter 7, refers to the thermohaline structure of the Kalloni Gulf and the seasonal variability as it arises from the model. Although it isn’t possible to make a detailed validation, an analytical comparison between the results from the observational method and the computed results from the model along the same axis is performed. The 3D circulation pattern emerged and the previous assumption from chapter 5 is rebutted, while the 3D circulation pattern of the gulf is established. In Chapter 8, the horizontal variability of the circulation in the Kalloni Gulf is studied. The 3D circulation is analyzed and verified from the kinetic energy. The existence of boundary currents in the gulf emerged for first time. A water budget computed for the basin and the residence time is calculated monthly. In the Chapter 10, an attempt was made to reach the study one step ahead. To combine all the information that was revealed from the framework until now and considering the strong presence of boundary currents, was judged crucial to study further the sensitivity of the general circulation of the gulf, to the surface and the lateral water fluxes. Thus, three sensitivity tracer experiments were developed.Προκειμένου να διερευνηθούν τα διάφορα ζητήματα που τέθηκαν στην παρούσα μελέτη, ορίστηκαν και προσεγγίστηκαν ορισμένοι στόχοι σε διαφορετικά κεφάλαια. Η έρευνα αρχικά εστιάζει σε μια προσέγγιση συνοπτικής κλίμακας μελετώντας τα in-situ δεδομένα, συνεχίζει ανεβάζοντας την κλίμακα σε εποχιακή μελέτη και στο τελευταίο κεφάλαιο η μελέτη εστιάζει σε μεγαλύτερη κλίμακα με τη μελέτη της απόκρισης του οικοσυστήματος στην κλιματική αλλαγή. Καθιερώθηκαν οι κλιματικές τάσεις για την περιοχή μελέτης και εφαρμόστηκε ένα μοντέλο ισοζύγιο νερού σε επίπεδο λεκάνης απορροής με στόχο να αναδείξει την επίδραση των κλιματικών τάσεων στο οικοσύστημα του κόλπου της Καλλονής

Anterolateral thigh harvesting for head and neck reconstruction without Doppler: Risky or not?

Background: Anterolateral thigh flap (ALT) is used as a workhorse flap for head and neck reconstruction. The most used method to map the perforators nowadays is hand-held Doppler although several more sophisticated techniques have been described. This paper is to investigate whether harvesting the ALT flap without preoperative mapping is safe. Materials and methods: Twenty consecutive patients were randomly assigned to one of two groups: A or B. Patients of A group (n = 10) were marked before the operation with the use of a Doppler probe whilst patients of group B (n = 10) were not marked preoperatively using Doppler to detect the perforators. Complications and time of ALT dissection were documented. Results: There was no statistical difference of complications between the two groups. Mean time of flap harvesting (skin incision up to main pedicle) was approximately 140 min in group A and 165 min in group B (statistically significantly less in group A p = 0.008). Conclusions: This paper is an indication that harvesting the ALT flap without preoperative mapping, even with hand-held Doppler, does not compromise safety of the procedure although operative time is prolonged

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 (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected