Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

2013 ◽  
Vol 33 (6) ◽  
pp. 57-66 ◽  
Author(s):  
Karen L. Cooper
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Critical Care Unit ◽  
Pressure Ulcers ◽  
Hemodynamic Instability ◽  
Evidence Based ◽  
Never Event ◽  
Vasoactive Medications ◽  
Critical Care Patients

The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.

Predictors of Pressure Ulcers in Adult Critical Care Patients

2011 ◽  
Vol 20 (5) ◽  
pp. 364-375 ◽  
Author(s):  
Jill Cox
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Critical Care Patients

BackgroundPressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.ObjectiveTo determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.MethodsA retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.ResultsAccording to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.ConclusionCurrent risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

2014 ◽  
Vol 34 (6) ◽  
pp. 15-27 ◽  
Author(s):  
Jill Cox ◽  
Louisa Rasmussen
Keyword(s):  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Pressure Ulcers ◽  
Burden Of Illness ◽  
Evidence Based ◽  
Adequate Nutrition ◽  
Nutritional Guidelines ◽  
Registered Dietician ◽  
Critical Care Patients

Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients’ burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes.

Hidden Obligatory Fluid Intake in Critical Care Patients

2016 ◽  
Vol 32 (3) ◽  
pp. 223-227 ◽  
Author(s):  
Muhammad Umair Bashir ◽  
Anan Tawil ◽  
Vishnu R. Mani ◽  
Umer Farooq ◽  
Michael A. DeVita
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Critical Care ◽  
Medical Records ◽  
Critical Care Unit ◽  
Fluid Intake ◽  
Icu Patients ◽  
Critical Care Admission ◽  
The Mean ◽  
Critical Care Patients

Introduction: In addition to the fluid intake in the form of intravenous maintenance or boluses in intensive care unit (ICU) patients, there are sources of fluids that may remain unrecognized but contribute significantly to the overall fluid balance. We hypothesized that fluids not ordered as boluses or maintenance infusions—“hidden obligatory fluids”—may contribute more than a liter to the fluid intake of a patient during any random 24 hours of critical care admission. Methods: Patients admitted to the Harlem Hospital ICU for at least 24 hours were included in this study (N = 98). Medical records and nursing charts were reviewed to determine the sources and volumes of various fluids for the study patients. Results: The mean hidden obligatory volume for an ICU patient was calculated to be 978 mL (standard deviation [SD]: 904, median: 645) and 1571 mL (SD: 1023, median: 1505), with enteral feeds compared to the discretionary volume of 2821 mL (SD: 2367, median: 2595); this obligatory fluid volume was affected by a patient’s need for pressor support and renal replacement therapy. Conclusion: Hidden obligatory fluids constitute a major source of the fluid intake among patients in a critical care unit. Up to 1.5 L should be taken into account during daily decision making to effectively regulate their volumes.

Risk Factors for Dexmedetomidine-Associated Hemodynamic Instability in Noncardiac Intensive Care Unit Patients

2016 ◽  
Vol 122 (2) ◽  
pp. 462-469 ◽  
Author(s):  
Calvin J. Ice ◽  
Heather A. Personett ◽  
Erin N. Frazee ◽  
Ross A. Dierkhising ◽  
Rahul Kashyap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hemodynamic Instability

Acute pancreatitis and renal replacement therapy

2019 ◽  
pp. 179-190
Author(s):  
Clinton Lobo ◽  
Kim Gupta ◽  
Matt Thomas
Keyword(s):  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on pancreatitis and renal replacement therapy. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Sedation and delirium

2019 ◽  
pp. 145-160
Author(s):  
Nim Pathmanathan ◽  
Paul Nixon
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Case History ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study of sedation and delirium. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Early management of multi-trauma

2019 ◽  
pp. 53-66
Author(s):  
Marius Rehn ◽  
David J. Lockey
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Early Management ◽  
Patient Pathway ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on multi-trauma and describes the patient pathway from the incident scene through to rehabilitation. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Pressure ulcer risk factors in an ICU population

1995 ◽  
Vol 4 (5) ◽  
pp. 361-367 ◽  
Author(s):  
MK Jiricka ◽  
P Ryan ◽  
MA Carvalho ◽  
J Bukvich
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Motor Vehicle ◽  
Convenience Sample ◽  
Medical Diagnoses ◽  
Trauma Population ◽  
Braden Scale

BACKGROUND: Although it is well known that pressure ulcers are associated with negative patient outcomes and increased hospital cost, there is little research related to pressure ulcers in an intensive care unit population. OBJECTIVE: To determine the relative contribution of risk factors in the development of pressure ulcers in intensive care unit patients. METHOD: In an exploratory descriptive design, a convenience sample of 85 adults was used. Patients were enrolled in the study within 24 hours of admission to the intensive care unit; data were collected every other day until discharge from the intensive care unit. Instruments included a demographic data form, Braden Scale for Predicting Pressure Sore Risk, Skin Assessment Tool, and Decubitus Ulcer Potential Analyzer. RESULTS: The most common reasons for admission to the intensive care unit included multiple trauma from motor vehicle accidents, gunshot and stab wounds, and gastrointestinal bleeding. A pressure ulcer developed in 48 subjects. There were no significant differences in age, gender, history of diabetes or smoking, or medical diagnoses between patients in whom a pressure ulcer developed and those in whom it did not. Data analysis indicated that a Braden Scale score of 11, rather than the recommended score of 16, was statistically significant for predicting pressure ulcer risk. CONCLUSIONS: The results suggest that a cut-off score on the Braden Scale could be specific to an intensive care unit trauma population.

Oral mucosa pressure ulcers in intensive care unit patients: A preliminary observational study of incidence and risk factors

2019 ◽  
Vol 28 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Chul-Hoon Kim ◽  
Myoung Soo Kim ◽  
Myung Ja Kang ◽  
Hyun Hee Kim ◽  
Nam Jung Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Oral Mucosa ◽  
Pressure Ulcers

scholarly journals Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Blaivas ◽  
Konstantinos Stefanidis ◽  
Serafim Nanas ◽  
John Poularas ◽  
Mitchell Wachtel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Upper Extremity ◽  
Strong Predictor ◽  
Venous Catheter ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Deep Vein ◽  
Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

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