Incidence of Pressure Ulcers In The Patients On Mechanical Ventilation: A Prospective Study

Year 2020, Volume: 10 Issue: 1, 62 - 69, 31.03.2020

Elif Karahan Sevim Çelik Özge Uçar

https://doi.org/10.16899/jcm.628095

Abstract

Aim: The
aim of this study was to determine the incidence of pressure ulcers among the
patients on mechanical ventilation.

Methods: The
type of the study was cross-sectional and prospective. It was carried out in 5
intensive care units of a state hospital located in Western Black Sea region of
Turkey. The sample of the study included 260 patients who began to get
mechanical ventilatory support. Pressure ulcer risk in patients was assessed by
Braden Risk Assessment Scale at 10th hour, 1st week and 2nd week timepoints
following the initiation of mechanical ventilatory support.

Results: Mean age of the patients was 54±10 years;  52.7% were males; and 55.4% had a Body Mass
Index within normal range. It was determined that 46.5% of the patients were
hospitalized due to the diagnosis of a cerebrovascular event; the state of
consciousness was confused in 52.3% and mean Braden Risk
Assessment Scale was 11.0±2.64. It was observed that
the incidence of pressure ulcers was 10.8% at 10th hour, 58.5% at first week
and 71.15% at second week following the beginning of mechanical ventilation
treatment. At the end of second week, stage1 pressure ulcer was developed on
the sacrum in 30% and on coccyx area in 22.7% of the patients.

Conclusion:It
was found that the incidence of pressure ulcer development risk was
significantly high among the patients who underwent mechanical ventilation
treatment. Considering the effect of mechanical ventilator and other factors,
taking primary protective precautions for preventing pressure ulcers was
suggested to be very important.

Keywords

Mechanical ventilation, Pressure ulcer, Intensive care

Mekanik Ventilatördeki Hastalarda Basınç Yarası İnsidansı: Prospektif Bir Çalışma

Abstract

Amaç: Bu
çalışmanın amacı mekanik ventilatördeki hastalarda basınç yarası insidansını belirlemektir.

Gereç
ve Yöntem: Araştırmanın tipi kesitsel tipte
prospektiftir. Batı Karadeniz Bölgesinde yer alan bir Devlet Hastanesinin 5
yoğun bakım ünitesinde yürütülmüştür. Araştırmanın örneklemini mekanik ventilasyon desteği başlatılan 260 hasta
oluşturmuştur. Braden Risk
Değerlendirme Ölçek puanı ile hastalardaki basınç yarası oluşma riski mekanik ventilasyon
desteği başladıktan sonra 10. saat, 1. hafta ve 2. hafta zaman dilimlerinde
değerlendirilmiştir. İstatistiksel analizlerde sayı, yüzde, ortalama, t testi, Anova ve Pearson Korelasyon analizi
kullanılmıştır.

Bulgular:
Hastaların yaş ortalaması 54±10 yaş;  %52.7’si erkek; %55.4’ünün Beden Kütle İndeksleri
normal aralıktadır.  Hastaların
%46.5’inde serebrovasküler olay tanısı ile yatış yapıldığı; %52.3’ünün  bilinç durumunun konfüze olduğu ve Braden Risk
Değerlendirme Ölçek puanının 11.0±2.64 şeklinde
yüksek risk grubunda olduğu belirlenmiştir. Kadın cinsiyette, bilinç durumu
stupor olan hastalarda ve motor yanıtı dokunma ile çekme tepkisi veren
hastalarda basınç yarası riski anlamlı olarak daha yüksektir. Mekanik
ventilasyon tedavisi başlatıldıktan sonraki 10. saatte
basınç yarası insidansının %10.8; birinci haftada %58.5; ikinci haftada %71.15
olduğu görülmüştür. İkinci haftanın sonunda hastaların %30’unda sakrum, %22.7’sinde
koksik bölgesinde Evre 1 basınç yarası gelişmiştir.

Sonuç:
Mekanik
ventilasyon tedavisi alan hastalarda ventilatörle ilişkili olarak basınç yarası
gelişme insidansının oldukça yüksek olduğu sonucu ortaya çıkmıştır. Mekanik
ventilatör ve diğer faktörlerin de etkisi göz önünde tutularak basınç yarasını
önleme konusunda primer koruma önlemlerinin alınması oldukça önemlidir.

Keywords

Mekanik ventilasyon, Basınç yarası, Yoğun bakım

References

• 1. National Pressure Ulcer Advisory Panel, Europan Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. (Publication No: 978-0-9579343-6-8) Cambridge Media: Perth, Australia. Emily Haesler (Ed.). Retrieved from https://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf. [Accessed on 18th October, 2019]
• 2. National Institute for Health and Care Excellence. (2014). Pressure ulcers: prevention and management, Clinical guideline. (Publication No: CG179). Retrieved from nice.org.uk/guidance/cg179. [Accessed on 18th October, 2019]
• 3. Apostolopoulou E, Tselebis A, Terzis K, Kamarinou E, Lambropoulos I, Kalliakmanis A. Pressure ulcer incidence and risk factors in ventilated intensive care patients. Health Science Journal.2014;8 (3):333-342
• 4. Borghardt AT, Prado TN, Bicudo SDS, Castro DS, Bringuente MEO. Pressure ulcers in critically ill patients: incidence and associated factors. Rev Bras Enferm. 2016;69(3):431-8. https://doi.org/10.1590/0034-7167.2016690307i
• 5. Cooper KL. Evidence-Based Prevention Of Pressure Ulcers ın The Intensive Care Unit Critical Care Nurse, 2013;33(6):57-67. https://doi.org/10.4037/ccn2013985
• 6. González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I,Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs. 2018 Mar;27(5-6):1028-1037https://doi.org/10.1111/jocn.14091
• 7. Nijs N, Toppets A, Defloor T, Bernaerts K, Milisen K, Van Den Berghe G.Incidence and risk factors for pressure ulcers in the intensive care unit. J Clin Nurs. 2009; 18(9):1258-66. doi: 10.1111/j.1365-2702.2008.02554.x.
• 8. Özyürek P., Yavuz Van Giersbergen M., Yildiz Ö., "Investigation of the risk factors of pressure ulcers in intensive care unit patient According to the Braden Scale", Eastern Journal of Medicine, 2016; 21(1):1-9. doi: 10.5505/ejm.2016.21939.
• 9. Karayurt Ö, Akyol Ö, Kılıçaslan N, Akgün N, Sargın Ü, Kondakçı M, et al. The incidence of pressure ulcer in patients on mechanical ventilation and effects of selected risk factors on pressure ulcer development. Turk J Med Sci. 2016; 46(5):1314-1322. https://doi.org/10.3906/sag-1504-139
• 10. Çınar F, Kula Şahin Ş, Eti Aslan F. Evaluation of studies in Turkey on the prevention of pressure sores ın the ıntensive care unit: a systematic review. Balıkesir Health Sciences Journal, 2018; 7(1): 42-50.
• 11. Wang XR, Han BR. Logistic regression analysis and nursing interventions for high-risk factors for pressure sores in patients in a surgical intensive care unit. Chinese Nursing Research, 2015; 2(2-3): 51-54. https://doi.org/10.1016/j.cnre.2015.04.004
• 12. Mitchell A. Adult pressure area care: preventing pressure ulcers. British Journal of Nursing. 2018; 4;27(18):1050-1052. doi: 10.12968/bjon.2018.27.18.1050.
• 13. Alderden J, Zhao YL, Zhang Y, Thomas D, Butcher R, Zhang Y, et al. Outcomes Associated With Stage 1 Pressure Injuries: A Retrospective Cohort Study. Am J Crit Care. 2018 Nov;27(6):471-476. doi: 10.4037/ajcc2018293.
• 14. Pınar R, Oğuz S. (1998). Norton ve Braden bası yarası değerlendirme ölçeklerinin yatağa bağımlı aynı hasta grubunda güvenirlik ve geçerliğinin sınanması: Uluslar arası Katılımlı VI. Ulusal Hemşirelik Kongresi, Kongre Kitabı, Ankara, 172-5.
• 15. Latifa K, Sondess S, Hajer G, Manel BH, Souhir K, Nadia B, et al. Evaluation of physiological risk factors, oxidant-antioxidant imbalance, proteolytic and genetic variations of matrix metalloproteinase-9 in patients with pressure ulcer. Scientific Reports. 2016; 11(6):29371. https://dx.doi.org/10.1038%2Fsrep29371
• 16. He M, Tang A, Ge X, Zheng j. Pressure Ulcers in the Intensive Care Unit: An Analysis of Skin Barrier Risk Factors. Adv Skin Wound Care. 2016;29(11):493-498.
• 17. Kıraner E, Terzi B, Uzun Ekinci A, Tunalı B. Characteristics of patients with pressure wound in the intensive care unit. Journal of the Turkısh Socıety of Crıtıcal Care Nurse. 2016; 20(2): 78-83.
• 18. Loudet CI, Marchena MC, Maradeo MR, Fernández SL, Romero MV, Valenzuela GE, et al. Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study. Rev Bras Ter Intensiva. 2017; 29(1):39-46.https://doi.org/10.5935/0103-507X.20170007
• 19. Mehta C, George JV, Mehta Y, Wangmo N. Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set. J Tissue Viability. 2015 Aug;24(3):123-30. https://doi.org/10.1016/j.jtv.2015.04.001
• 20. Garcez Sardo PM, Simões CS, Alvarelhão JJ, de Oliveira e Costa CT, Simões CJ, Figueira JM, et al. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital. J Tissue Viability. 2016 May;25(2):75-82. https://doi.org/10.1016/j.jtv.2016.02.006