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Posted: May 16th, 2023
Pressure injury risk and care considerations for ICU patients
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Pressure injuries (PIs) are a common and serious complication for patients admitted in the intensive care unit (ICU). PIs are associated with increased morbidity, mortality, length of stay, and health care costs . ICU patients have a higher risk of developing PIs than non-ICU patients, due to their acute illness, underlying conditions, organ support, and device use . Therefore, ICU patients require specific assessment and prevention strategies to reduce the incidence and severity of PIs.
Some of the risk factors for PI development in ICU patients are intrinsic, such as age, comorbidities, nutritional status, perfusion, oxygenation, and inflammation . Others are extrinsic, such as pressure, shear, friction, moisture, and medical devices . These factors can impair the skin integrity and tissue viability, leading to skin breakdown and ulceration. To prevent PIs in ICU patients, nurses should perform regular skin assessment using validated tools such as the Braden Scale or the Pressure Ulcer Risk Assessment Scale for Intensive Care (PURAS-IC) . Nurses should also implement evidence-based interventions such as repositioning, using appropriate support surfaces, managing moisture and incontinence, optimizing nutrition and hydration, and protecting bony prominences and device-related areas with prophylactic dressings .
However, despite these preventive measures, some PIs may be unavoidable in ICU patients due to their critical condition and complex needs. A study by Pittman et al. found that 41% of HAPIs in critical and progressive care units were unavoidable. The authors identified some factors that differentiated avoidable from unavoidable HAPIs, such as congestive heart failure, sedation, hypotension, vasopressor use, bowel management devices, length of stay, and previous pressure injury. They suggested that these factors could be used to guide clinical decision-making and quality improvement initiatives. They also emphasized the importance of documenting the preventive interventions and the rationale for their implementation or omission.
In conclusion, PIs are a major challenge for ICU patients and health care providers. They require careful assessment and prevention strategies that are tailored to the specific needs and risks of this population. However, some PIs may be unavoidable due to the nature and severity of the critical illness. Therefore, nurses should use their clinical judgment and evidence-based criteria to determine the avoidability of PIs and to provide optimal care for ICU patients.
Works Cited
: Coyer F., Labeau S., Blot S. Preventing pressure injuries among patients in the intensive care unit: insights gained. Intensive Care Med. 2022;48:1787–1789. https://doi.org/10.1007/s00134-022-06838-3
: Black J.M., Cuddigan J.E., Walko M.A., Didier L.A., Lander M.J., Kelpe M.R. Medical device related pressure ulcers in hospitalized patients. Int Wound J. 2010;7(5):358–365. https://doi.org/10.1111/j.1742-481X.2010.00717.x
: Cox J., Roche S., Van Wynsberghe S., et al. Predictors of pressure injuries in adult critical care patients: A retrospective cohort study. Am J Crit Care. 2017;26(6):448–456. https://doi.org/10.4037/ajcc2017798
: Kottner J., Balzer K., Dassen T., Heinze S. Factors associated with pressure ulcers in the intensive care unit: A systematic review. J Clin Nurs. 2013;22(11–12):1525–1534. https://doi.org/10.1111/jocn.12018
: Shahin E.S.M., Dassen T., Halfens R.J.G. Pressure ulcer prevalence in intensive care patients: A cross-sectional study. J Eval Clin Pract. 2009;15(2):264–268. https://doi.org/10.1111/j.1365-2753.2008.00984.x
: National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (The International Guideline). Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.
: Coyer F.M., Stotts N.A., Blackman V.S. A prospective window into medical device-related pressure ulcers in intensive care. Int Wound J. 2014;11(6):656–664. https://doi.org/10.1111/iwj.12101
: Pittman J., Beeson T., Dillon J., Yang Z., Cuddigan J. Hospital-acquired pressure injuries in critical and progressive care: Avoidable versus unavoidable. Am J Crit Care. 2019;28(5):338–350. https://doi.org/10.4037/ajcc2019264
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