Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses.

PURPOSE: The objective was to compare the effectiveness of repositioning every 2 or 4 h for preventing pressure ulcer development in patients in intensive care unit under mechanical ventilation (MV). METHODS: This was a pragmatic, open-label randomized clinical trial in consecutive patients on an alternating pressure air mattress (APAM) requiring invasive MV for at least 24 h in a university hospital in Spain. Eligible participants were randomly assigned to groups for repositioning every 2 (n = 165) or 4 (n = 164) h. The primary outcome was the incidence of a pressure ulcer of at least grade II during ICU stay. RESULTS: A pressure ulcer of at least grade II developed in 10.3% (17/165) of patients turned every 2 h versus 13.4% (22/164) of those turned every 4 h (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.46-1.71, P = 0.73). The composite end point of device-related adverse events was recorded in 47.9 versus 36.6% (HR 1.50, CI 95% 1.06-2.11, P = 0.02), unplanned extubation in 11.5 versus 6.7% (HR 1.77, 95% CI 0.84-3.75, P = 0. 13), and endotracheal tube obstruction in 36.4 versus 30.5%, respectively (HR 1.44, 95% CI 0.98-2.12, P = 0.065). The median (interquartile range) daily nursing workload for manual repositioning was 21 (14-27) versus 11 min/patient (8-15) (P < 0.001). CONCLUSIONS: A strategy aimed at increasing repositioning frequency (2 versus 4 h) in patients under MV and on an APAM did not reduce the incidence of pressure ulcers. However, it did increase device-related adverse events and daily nursing workload.

Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation.

RATIONALE, AIMS AND OBJECTIVES: Pressure ulcers (PUs) are a common and serious complication in critically ill patients. The aim of this study was to evaluate the relationship between the development of a PU and hospital mortality in patients requiring mechanical ventilation (MV) in an intensive care unit (ICU). METHODS: A prospective cohort study was performed over two years in patients requiring MV for ≥ 24 hours in a medical-surgical ICU. Primary outcome measure was hospital mortality and main independent variable was the development of a PU grade ≥ II. Hazard ratios (HRs) were calculated using a Cox model with time-dependent covariates. RESULTS: Out of 563 patients in the study, 110 (19.5%) developed a PU. Overall hospital mortality was 48.7%. In the adjusted multivariate model, PU onset was a significant independent predictor of mortality (adjusted HR, 1.28; 95% confidence interval, 1.003-1.65; P = 0.047). The model also included the Acute Physiology and Chronic Health Evaluation II score, total Sequential Organ Failure Assessment on day 3, hepatic cirrhosis and medical admission. CONCLUSION: Within the limitations of a single-centre approach, PU development appears to be associated with an increase in mortality among patients requiring MV for 24 hours or longer.