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.

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.

Nutrition

2019 ◽  
pp. 188-196
Author(s):  
George W. Williams
Keyword(s):  
Infectious Disease ◽  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Respiratory Function ◽  
Surgical Patients ◽  
Nutritional Management ◽  
Equal Degree ◽  
Perioperative Nutrition

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

2015 ◽  
Vol 35 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Ryan M. Rivosecchi ◽  
Pamela L. Smithburger ◽  
Susan Svec ◽  
Shauna Campbell ◽  
Sandra L. Kane-Gill
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Hospital Costs ◽  
Evidence Based ◽  
Inpatient Settings ◽  
Stay Hospital ◽  
Critical Care Patients

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

scholarly journals Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients

2017 ◽  
Vol 37 (4) ◽  
pp. e1-e11 ◽  
Author(s):  
Xiaohong Deng ◽  
Ting Yu ◽  
Ailing Hu
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Pressure Ulcers ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Braden Scale ◽  
Hospital Acquired ◽  
Critical Care Patients

BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models’ predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value

scholarly journals Impact of a Nutritional Formula Enriched in Fish Oil and Micronutrients on Pressure Ulcers in Critical Care Patients

2012 ◽  
Vol 21 (4) ◽  
pp. e102-e109 ◽  
Author(s):  
M. Theilla ◽  
B. Schwartz ◽  
J. Cohen ◽  
H. Shapiro ◽  
R. Anbar ◽  
...  
Keyword(s):  
Critical Care ◽  
Fish Oil ◽  
Pressure Ulcers ◽  
Critical Care Patients

scholarly journals Povezave med razjedo zaradi pritiska in ohranjanjem integritete kože pacienta v intenzivni zdravstveni obravnavi: pregled literature

2015 ◽  
Vol 49 (4) ◽  
Author(s):  
Dragica Emeđi ◽  
Brigita Skela-Savič
Keyword(s):  
Critical Care ◽  
Quality Of Care ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Pressure Ulcer Prevention ◽  
Skin Integrity ◽  
Prevention And Treatment ◽  
Critical Care Patients ◽  
Ulcer Prevention

Uvod: Namen raziskave je prikazati večdimenzionalne potrebe in možne dejavnike tveganja za razjedo zaradi pritiska pri odraslih pacientih v intenzivni zdravstveni obravnavi. Metode: Uporabili smo analizo in sintezo pregleda dokazov iz zbirke podatkov EMERALD, CINAHL, PubMed in ProQuest. Ključne iskalne besedne zveze so bile: »quality of care«, »pressure ulcer«, »prevention and treatment of pressure ulcers«, »skin integrity critical care patients«. Omejitveni kriteriji iskanja so bili: obdobje 2010 do 2013, celotno besedilo člankov v angleščini. Začetna merila je izpolnjevalo 280 zadetkov in 40 izbranih ustreznih prispevkov. Potek raziskave je prikazan v skladu z načeli Cochranove zbirke, ocena kakovosti dokazov pa v hierarhiji dokazov. Rezultati: Identificiranih je 191 kod, ki so združene v 11 vsebinskih kategorij: okolje intenzivne terapije – značilnosti nekaterih dejavnikov tveganja, čas bivanja v enoti, vazoaktivne učinkovine, spol, starost, administrativno diagnostična kategorija, postelja, ležišče, lestvica Waterlow, razjeda zaradi pritiska in pomen prve stopnje razjede. Diskusija in zaključek: Raziskava pokaže pomen uvedbe proaktivnih ukrepov za ohranjanje integritete kože pacienta. Osredotoča se na vitalnost tkiva in promocijo kakovostne zdravstvene oskrbe z vidika teorije. Potrebne so raziskave, ki bi za boljše razumevanje pojasnjevale številna druga tveganja in učinkovite programe za vitalnost kože.

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.

scholarly journals Top 10 publications of Intensive Care Medicine journal 2020

2020 ◽  
Vol 5 (4) ◽  
pp. 89-96
Author(s):  
Е. V. Grigoriev ◽  
O. N. Ivanova ◽  
V. V. Krasnov ◽  
V. V. Zhdanov
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Evidence Based ◽  
Medicine Journal ◽  
Number Of Patients ◽  
Evidence Based Guidelines ◽  
Critical Care Patients

COVID-19 pandemic provoked an increasing interest in recent advances in diagnosis and treatment of critical care patients. Among the main problems are the lack of evidence-based guidelines and a growing number of patients with multiple organ dysfunction syndrome. Therefore, indications for the use of previously uncommon intensive care approaches are expanding. These reasons, along with a large pool of non-systematic literature, dictate the need in the narrative review of top 10 recent publications which provide a snapshot of the most relevant research in critical care. These papers overview evidence-based information on the control of acute kidney injury, ventilator-associated pneumonia and sepsis in critically ill patients including those with COVID-19, principles of proper haemodynamic and ventilatory support, timely cessation of antimicrobial therapy, efficient prevention of gastrointestinal bleeding, and the use of the prone position in patients with acute respiratory distress syndrome.

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