Yoğun bakımda takip edilen COVID-19 hastalarında bası yarası gelişimi ve risk faktörlerinin değerlendirilmesi

Abstract

Amaç: Bu çalışmada, yoğun bakım ünitesinde takip edilen COVID-19 hastalarında basınç yarası gelişiminin nedenlerini değerlendirmek amaçlanmıştır. Yöntemler: Hastaların demografik verileri, eşlik eden hastalıklar, laboratuvar parametreleri, tedavi yöntemleri ve mortalite oranları hastane kayıtlarından retrospektif olarak incelendi. Ayrıca, Akut Fizyoloji ve Kronik Sağlık Değerlendirme (APACHE II), Sıralı Organ Yetmezlik Değerlendirme (SOFA) ve modifiye NUTRIC skorları hesaplandı. Basınç yarası değerlendirmesi için Braden ölçeği kullanıldı. Bulgular: Çalışmaya seksen COVID-19 hastası dahil edildi. Vakaların 29'unda (%36,25) basınç yarası tespit edilirken, 51'inde (%63,75) basınç yarası tespit edilmedi. Hastaların 54'ü (%69,7) erkek, 26'sı (%32,5) kadın ve ortalama yaş 69 (61-77) idi. Vakalar, basınç yarası gelişimine göre iki gruba ayrıldı. APACHE II skoru PU grubunda 24 (17-29) iken, PU olmayan grupta 18 (12-23) idi (p=0,01); mNUTRIC skoru PU grubunda 4 (3-5) iken, PU olmayan grupta 3 (2-4) idi (p=0,023); yoğun bakıma kabulde hesaplanan Braden ölçeği skoru PU grubunda 11 (10-13) iken, PU olmayan grupta 14 (12-15) idi (p<0,001). Braden ölçeği skoru <13 olan hasta sayısı PU grubunda 22 (%75,9) iken, PU olmayan grupta 14 (%27,5) ve toplamda 36 (%45) hastada bulundu (p<0,001). Sonuç: COVID-19 hastalarında Braden Ölçeği, yoğun bakıma ilk kabul edildikleri için hem yaranın skorlanması hem de prognozun hızlı bir şekilde tahmin edilmesi için kullanılabilir.

Keywords

• COVID-19
• Basınç yarası
• Yoğun bakım ünitesi
• Braden Ölçeği
• Mortalite

Evaluation of pressure ulcer development and risk factors in COVID-19 patients followed in the ICU

Abstract

Aims: In this study it was aimed to evaluate the causes of pressure ulcer development in COVID-19 patients followed in the intensive care unit (ICU). Methods: Demographic data, comorbidities, laboratory parameters, treatment modalities and mortality rates of the patients were reviewed retrospectively from hospital records. In addition, Acute Physiology and Chronic Health Assessment (APACHE II), Sequential Organ Failure Assessment (SOFA), and modified NUTRIC scores were calculated. Braden scale was used for pressure ulcer evaluation. Results: Eighty COVID-19 patients were included in the study. Pressure ulcers (PU) were detected in 29 (36.25%) of the cases, and no pressure ulcer was detected in 51 (63.75%) cases. 54 (69.7%) of the patients were male, 26 (32.5%) were female, and the mean age was 69 (61-77). The cases were divided into two groups according to the development of pressure ulcers. The APACHE II score was 24 (17-29) in the PU group and 18 (12-23) in the non-PU group (p=0.01), the mNUTRIC score was 4 (3-5) in the PU group and 3 (2-4) in the non-PU group.) (p=0.023), the Braden scale calculated at admission to the ICU was 11(10-13) in the PU group and 14(12-15) (p<0.001) in the non-PU group. A Braden scale score of <13 was found to be 22 (75.9) in the PU group and 14 (27.5) in the non-PU group, and 36 (45) patients in total (p<0.001). Conclusion: The Braden Scale can be used in COVID-19 patients, since they are first admitted to the ICU, both for scoring the wound and predicting the (making a) prognosis quickly.

Keywords

• COVID-19
• Pressure Ulcer
• ICU
• Braden Scale
• Mortality

References

1. (WHO) WHO. Q&A on coronaviruses (COVID-19). Accessed july 6, 2020. https://who.int/news-room/q-a-detail/q-a-coronaviruses
2. Sun P, Qie S, Liu Z, Ren J, Xi J. Clinical characteristics of 50466 patients with 2019-nCoV infection. MedRxiv. 2020.
3. Montenegro F, Unigarro L, Paredes G, et al. Acute respiratory distress syndrome (ARDS) caused by the novel coronavirus disease (COVID-19): a practical comprehensive literature review. Exp Rev Respir Med. 2021;15(2):183-195.
4. Grasselli G, Greco M, Zanella A, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-1355. doi:10.1001/jamainternmed.2020.3539
5. WHO. Coronaviruses disease 2019 (COVID-19). 2019; https://www.who.int/emergencies/diseases/novel-coronavirus-2019
6. Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs. 2006;54(1):94-110. doi:10.1111/j.1365-2648.2006.03794.x
7. Beers MH, Berkow R. The Merck Manual of Geriatrics. Merck & Co. Inc Whitehouse Station, NJ. 2000;
8. KIRANER E, Hülya K. COVID-19 Tanısı ile yoğun bakımda yatan hastalarda basınç yaralanmalarının ve risk faktörlerinin retrospektif analizi. Yoğun Bakım Hemşireliği Derg. 2021;25(3):139-151.

9. Karahan A, AAbbasoğlu A, Işık SA, et al. Factors Affecting Wound Healing in Individuals With Pressure Ulcers: A Retrospective Study. Ostomy/Wound Manage. 2018;64(2):32-39.
10. de Araújo TM, de Araújo MFM, Barros LM, de Oliveira FJG, da Silva LA, Caetano JÁ. Educational intervention to assess the knowledge of intensive care nurses about pressure injury. Rev Rene. 2019;(20):42.
11. GENCER ZE, Erdinç Ü, ÖZKAN Ö. Basınç ülserleri tedavi maliyetleri etkililik analizi; konvansiyonel ve modern yara bakım tedavi maliyetlerinin karşılaştırılması. Akdeniz Tıp Derg. 2019;5(2):201-208.
12. Tanrikulu F, Dikmen Y. Yoğun bakım hastalarında basınç yaraları: risk faktörleri ve önlemler. J Hum Rhythm. 2017;3(4):177-182.
13. Lovicu E, Faraone A, Fortini A. Admission braden scale score as an early independent predictor of in‐hospital mortality among inpatients with COVID‐19: a retrospective cohort study. Worldviews Evid Based Nurs. 2021;18(5):247-253.
14. Bandle B, Ward K, Min SJ, et al. Can Braden score predict outcomes for hospitalized heart failure patients? J Am Geriatr Soc. 2017;65(6):1328-1332.
15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829.
16. Vincent J-L, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Springer-Verlag; 1996.
17. Zhang P, He Z, Yu G, et al. The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr. 2021;40(2):534-541.
18. Defloor T, Schoonhoven L, Fletcher J, et al. Statement of the European Pressure Ulcer Advisory Panel--pressure ulcer classification: differentiation between pressure ulcers and moisture lesions. J Wound Ostomy Continence Nurs. 2005;32(5):302-306. doi:10.1097/00152192-200509000-00006
19. Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011;20(5):364-375.
20. Bergstrom N, Demuth PJ, Braden B. A clinical trial of the Braden Scale for predicting pressure sore risk. Nurs Clin North Am. 1987;22(2):417-428.
21. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. doi:10.1016/j.clnu.2018.08.037
22. Mechanick JI, Carbone S, Dickerson RN, et al. Clinical nutrition research and the COVID‐19 pandemic: a scoping review of the ASPEN COVID‐19 task force on nutrition research. JPEN J Parenter Enteral Nutr. 2021;45(1):13-31.
23. Reuler JB, Cooney TG. The pressure sore: pathophysiology and principles of management. Ann Intern Med. 1981;94(5):661-666.
24. Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289(2):223-226.
25. Kurtuluş Z. Braden skalası ile belirlenen yüksek riskli hasta grubunda albümin düzeyleri ile bası yaraları arasındaki ilişki. Marmara Universitesi (Turkey); 2003.
26. Armstrong R, Kane A, Kursumovic E, Oglesby F, Cook TM. Mortality in patients admitted to intensive care with COVID‐19: an updated systematic review and meta‐analysis of observational studies. Anaesthesia. 2021;76(4):537-548.
27. Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Crit Care Nurse. 2013;33(6):57-66.
28. Coleman S, Nixon J, Keen J, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222-2234.
29. Haisley M, Sørensen J, Sollie M. Postoperative pressure injuries in adults having surgery under general anaesthesia: systematic review of perioperative risk factors. J Br Surg. 2020;107(4):338-347.
30. NPUAP. 2014; Available at: https://www.epuap.org/wp-content/uploads/2010/10/NPUAP-EPUAP-PPPIA-Quick-Reference-Guide-2014-DIGITAL.pdf
31. Berlowitz DR, Brandeis GH, Morris JN, et al. Deriving a risk‐adjustment model for pressure ulcer development using the minimum data set. J Am Geriatr Soc. 2001;49(7):866-871.
32. Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Exp Rev Hematol. 2020;13(11):1265-1275.
33. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78(10):1186-1194.
34. Borghardt AT, Prado TN, Bicudo SD, Castro DS, Bringuente ME. Pressure ulcers in critically ill patients: incidence and associated factors. Úlcera por pressão em pacientes críticos: incidência e fatores associados. Rev Bras Enferm. 2016;69(3):460-467. doi:10.1590/0034-7167.2016690307i
35. Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-887. doi:10.1007/s00134-020-06022-5