Clark, Michele

Coyer, Fiona

Edwards, Chris

Ingleman, Jessica

McNamara, Greg

Ousey, Karen

Slattery, Peter

Stephenson, John

Thomas, Peter

University of Huddersfield Repository

University of Huddersfield RepositoryCoyer, Fiona, Clark, Michele, Slattery, Peter, Thomas, Peter, McNamara, Greg, Edwards, Chris, Ingleman, Jessica, Stephenson, John and Ousey, KarenExploring pressure and body positioning: a pilot evaluation among critically ill patientsOriginal CitationCoyer, Fiona, Clark, Michele, Slattery, Peter, Thomas, Peter, McNamara, Greg, Edwards, Chris, Ingleman, Jessica, Stephenson, John and Ousey, Karen (2016) Exploring pressure and body positioning: a pilot evaluation among critically ill patients. In: WUWHS World Union of Wound Healing Societies, 25­29 September 2016, Florence, Italy. (Unpublished) This version is available at http://eprints.hud.ac.uk/30923/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not­for­profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/EXPLORING PRESSURE AND BODY POSITIONING: A PILOT EVALUATION AMONG CRITICALLY ILL PATIENTSFiona Coyer1,2,3, Michele Clark2, Peter Slattery1, Peter Thomas1, Greg McNamara1, Chris Edwards2, Jessica Ingleman2, John Stephenson3, Karen Ousey3.1. Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia. 2. Queensland University of Technology, Brisbane, Queensland, Australia.3. University of Huddersfield, Huddersfield, West Yorkshire, UK.Aims• To investigate the effect of body mass index (BMI), severity of illness, positioning, age and risk of PI development on pressure displacement and interface pressure (IP)Source: http://www.heart-valve-surgery.com/Images/icu-tubes.jpgQueensland University of TechnologyRoyal Brisbane and Women’s HospitalParticipantsN=9 BMI (24.5 or <)(n=3)SOFA score  <4.9Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)SOFA score >5Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)Healthy adultMeasures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2N=9 BMI (25-29.5)(n=3)SOFA score  <4.9Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)SOFA score >5Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)Healthy adultMeasures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2N=9 BMI (30 or >)(n=3)SOFA score  <4.9Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)SOFA score >5Measures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2(n=3)Healthy adultMeasures: 3 positions (supine 30o; prone, 1/4 lateral turn) each x 2Participants further sub-divided by health status based on sequential organ failure assessment (SOFA) score  Participants aged >18 years sub-divided by BMI category (normal, overweight and obese)low acuity  (SOFA<4.5)Patients with burn injuries (>40% total burn surface area) excluded from studyhigh acuity (SOFA≥4.5) healthy adults (no SOFA score)Measures• Primary outcome measures1. Interface pressure (IP)• Xsensor X3 pressure mapping system - full body sensor mat (81cm x 203cm); 1,664 capacitive pressure sensors• IP measured as peak pressure index (PPI) and defined as highest recorded value with a 9-10 cm2 area• approximate contact area of a bony prominence.VariablesAll participants• Age• Gender • Comorbidities • Body mass indexCritically ill patients only • Diagnosis• ICU length of stay• Acuity• Sequential organ failure assessment (SOFA) score• Braden scale score• Risk assessment for pressure injury developmentResults - Participant characteristics• Mean participant age 50 years (SD 18.3) years• 58% male • Healthy adults all non-smokers; no comorbidities• Healthy adults about 20 years younger than ICU patients• Age confounded with patient type• Need to control for age in models assessing effect of acuity• Median Braden scale score 13 (IQR: 11-23) for ICU patients • Median length of ICU stay 14.5 (IQR: 8.0-20.5) daysResults: Variation in PPI with SOFA and BMIPPI values vary between patient typesLower values in healthy adults and low acuity patientsHigher values recorded at greater trochanter than at sacrumPPI values vary between patients with different BMI levelsHigher values recorded at greater trochanter than at sacrumSummary of analysis of PPI data• Participant type substantively related to PPI at sacrum and greater trochanter assessed jointly (p=0.093) • PPI values for high acuity patients 13.1 mmHg higher (95% CI -17.1 to 43.1 mmHg) at sacrum and 32.5 mmHg higher (95% CI -5.03 to 70.0 mmHg) at greater trochanter than for healthy adults• PPI values for low acuity patients 2.67 mmHg higher (95% CI -17.5 to 22.9 mmHg) at sacrum and 2.90 mmHg higher (95% CI -22.3 to 28.1 mmHg) at greater trochanter than for healthy adults• Model controlled for age; statistically significant (p=0.008)• Moderate to large effect (partial-η2=0.351) • No evidence of association between PPI and either BMI or patient type; or either Braden or SOFA scores (ICU patients only)Conclusion and recommendations• Peak pressure index is an under-reported phenomenon in the critically ill patient population and literature • This pilot analysis has determined several associations of importance• Substantive differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers. • Variation in IPs for sacral and greater trochanter areas depend on BMI categories and level of participants’ health status• Further work is recommended on a larger scale in the critically ill patient population using ‘real time’ periods of load to provide indication of optimum repositioning time for these vulnerable patientsReferences• Australian Wound Management Association. 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Exploring pressure and body positioning: a pilot evaluation among critically ill patients

Exploring pressure and body positioning: a pilot evaluation among critically ill patients

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