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

Measuring Diffusion Coefficients of the Ceria Phase in a Dual-Phase Oxygen Permeation Membrane Using a Combined Polarization - Kelvin Probe Force Microscopy Method

Dual-phase membranes with FeCo2O4 or its iron-rich pendant Fe2CoO4 and Gd-doped ceria as an oxygen ion conductor have already been successfully applied as oxygen permeation membranes with high permeability in the temperature range above 800 °C [1-3]. Apart from Gd-doped ceria, Sm-doped ceria also can be an interesting alternative in this kind of composite due to its high ionic conductivity [4].As especially ceria or ceria-based composites have gained more and more interest for low-temperature applications, e.g. as catalyst materials, current research efforts are aiming to improve the composition and microstructure of such dual-phase membranes for application in a membrane reactor at considerably lower temperatures (below 600 °C) to perform partial oxidation reactions. For temperatures between 600-1200 °C the defect chemistry of these materials is well established, but experimental data for low temperature charge transport are limited and not fully understood, yet.Kelvin Probe Force Microscopy (KPFM) is an Atomic Force Microscopy (AFM)-based measurement method which can measure the local surface potential (or from the physics view: the Volta potential) of the sample [5, 6]. The surface potential is a measure for local changes of the defect chemistry, as it is directly related to the local Fermi niveau [7]. The implications of local oxidation and reduction at low temperatures for charge carrier mobility in pure ceria, and especially in dual-phase materials, are not very well understood so far, but KPFM can be used to measure the surface potential difference directly at the polarized contact area as well as to map the time-dependent relaxation process of the introduced gradient, also giving information about the local surface potential distribution, lateral extent of the gradient, variations of the shape of the gradient etc. [8, 9].In the present study, single ceria grains in a dual-phase Ce0.8Sm0.2O2-δ + FeCo2O4 oxygen permeation membrane were polarized at room temperature in ambient air using a Pt-coated AFM tip and a large silver paste back contact. Subsequently, the introduced defect concentration gradient (which is visible as a gradient of the surface potential) and the relaxation process over time was monitored by KPFM.By comparing the measurement results to previously acquired data of single phase ceria samples with different doping concentrations and crystallinity, we were able to show that by this technique, chemical diffusion coefficients of a single phase in a composite material are accessible.Acknowledgements:The work was funded by the German Research Foundation - project #387282673.Literature: 1 Ramasamy, M.; Baumann, S.; Palisaitis, J.; Schulze‐Küppers, F.; Balaguer, M.; Kim, D.; Meulenberg, W. A.; Mayer, J.; Bhave, R.; Guillon, O. J Amer Ceram Soc 2016, 99 (1), 349-355. 2 Ramasamy, M.; Persoon, E. S.; Baumann, S.; Schroeder, M.; Schulze-Küppers, F.; Görtz, D.; Bhave, R.; Bram, M.; Meulenberg, W. A. Journal of membrane science 2017, 544, 278-286. 3 Lin, Y.; Fang, S.; Su, D.; Brinkman, K. S.; Chen, F. Nature Comm 2015, 6 (1), 1-9. 4 Mori, T.; Drennan, J.; Lee, J.-H.; Li, J.-G.; Ikegami, T. Solid State Ionics 2002, 154-155, 461-466. 5 Örnek, C.; Leygraf, C.; Pan, J. Corr Eng Sci Tech 2019, 54 (3), 185-198. 6 Melitz, W.; Shen, J.; Kummel, A. C.; Lee, S. Surf Sci Rep 2011, 66 (1), 1-27. 7 Zhang, Z.; Yates, J. T. Chem Rev 2012, 112 (10), 5520-5551. 8 Neuhaus, K.; Schulze-Küppers, F.; Baumann, S.; Ulbrich, G.; Lerch, M.; Wiemhöfer, H.-D. Solid State Ionics 2016, 288, 325-330. Lee, W.; Lee, M.; Kim, Y.-B.; Prinz, F. B. Nanotechnology 2009, 20 (44), 445706

The in situ generated emerging phase inside dual phase oxygen transport membranes

The in situ generated emerging phase inside the dual-phase oxygen transport membranes (DP-OTMs) plays a crucial role in boosting the overall performance of DP-OTMs. However, its detailed structure and properties are still not fully understood. Utilizing advanced transmission electron microscopy (TEM) techniques, the emerging phase GdxCe1-xFeyCo1-yO3-δ (GCFCO) inside the CexGd1-xO2-δ-FeCo2O4 (CGO-FC2O) OTMs was successfully characterized at the atomic scale. The newly formed GCFCO is primarily surrounded by the CGO, and contributes to a significant reduction of non-solute segregation at the CGO grain boundaries. Electronic characteristics of the GCFCO shows a sensitive dependence on its chemical composition, including the valence state of Ce and Fe as well as the oxygen vacancies. Additional CGO-GCFCO interfaces were introduced, where almost intact crystal structures were observed with slight Gd and Co segregation ∼1 nm at the edges. Approaching the interface, on the CGO side, only a minimum drop of the Ce valence was determined. On the GCFCO side, mixed Ce3+ and Ce4+ are partially occupying the Gd sites, while Fe and Co valence stay constant until the edge. Our study provides novel insight into the phase information within CGO-FC2O composites, which paves the path towards superior performance of various DP-OTMs

The in situ generated emerging phase inside dual phase oxygen transport membranes

The in situ generated emerging phase inside the dual-phase oxygen transport membranes (DP-OTMs) plays a crucial role in boosting the overall performance of DP-OTMs. However, its detailed structure and properties are still not fully understood. Utilizing advanced transmission electron microscopy (TEM) techniques, the emerging phase GdxCe1-xFeyCo1-yO3-δ (GCFCO) inside the CexGd1-xO2-δ-FeCo2O4 (CGO-FC2O) OTMs was successfully characterized at the atomic scale. The newly formed GCFCO is primarily surrounded by the CGO, and contributes to a significant reduction of non-solute segregation at the CGO grain boundaries. Electronic characteristics of the GCFCO shows a sensitive dependence on its chemical composition, including the valence state of Ce and Fe as well as the oxygen vacancies. Additional CGO-GCFCO interfaces were introduced, where almost intact crystal structures were observed with slight Gd and Co segregation ∼1 nm at the edges. Approaching the interface, on the CGO side, only a minimum drop of the Ce valence was determined. On the GCFCO side, mixed Ce3+ and Ce4+ are partially occupying the Gd sites, while Fe and Co valence stay constant until the edge. Our study provides novel insight into the phase information within CGO-FC2O composites, which paves the path towards superior performance of various DP-OTM

Measurement of polarization effects in dual-phase ceria-based oxygen permeation membranes using Kelvin probe force microscopy

In this study, a dual phase composite (CSO-FC2O) consisting of 60 vol % Ce0.8Sm0.2O1.9 as oxygen-conductive phase and 40 vol % FeCo2O4 as electron-conductive phase was synthesized. TEM measurements showed a relatively pure dual-phase material with only minor amounts of a tertiary (Sm,Ce)(Fe,Co)O3 perovskite phase and isolated residues of a rock salt phase at the grain boundaries. The obtained material was used as a model to demonstrate that a combination of polarization relaxation measurements and Kelvin probe force microscopy (KPFM)-based mapping of the Volta potential before and after the end of polarization can be used to determine the chemical diffusion coefficient of the ceria component of the composite. The KPFM measurements were performed at room temperature and show diffusion coefficients in the range of 3 × 10−13 cm2·s−1, which is comparable to values measured for single-phase Gd-doped ceria thin films using the same method

Phase formation and performance of solid state reactive sintered Ce 0.8 Gd 0.2 O 2− δ –FeCo 2 O 4 composites

Reactive sintering of dual phase composites for use as oxygen transport membranes is a promising method enabling lower sintering temperatures as well as low-cost raw materials. Ce0.8Gd0.2O2−δ–FeCo2O4 composites with different nominal weight ratios from 60 : 40 to 90 : 10 are processed by reactive sintering of commercial Ce0.8Gd0.2O2−δ, Fe2O3, and Co3O4 powders. The phases formed in situ during sintering are investigated qualitatively and quantitatively by means of XRD and Rietveld refinement as well as transmission electron microscopy. Besides gadolinia-doped ceria, two Fe/Co-spinel phases are in equilibrium in agreement with the phase diagram. Moreover, a donor-doped GdFeO3-based perovskite (Gd,Ce)(Fe,Co)O3 showing electronic conductivity is formed. Due to these intense phase reactions, the composition of each individual phase is assessed for all composites and their functional properties are discussed. The oxygen permeation performances of the composites are measured including their dependence on temperature and the potential limiting steps are discussed. The results reveal that the phase reactions support the formation of the desired mixed ionic electronic conductivity achieving percolation at low nominal spinel contents. The specific microstructure plays an extremely important role in the membrane performance and, thus, special attention should be paid to this in future research about dual phase membranes