Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil.

OBJECTIVES: To evaluate the incidence and risk factors of pressure ulcers (PU) in adult patients admitted to intensive care units (ICUs), as well as the outcome (including ICU and hospital mortality) of these patients. METHODS: Epidemiological cohort multicenter prospective study, evaluating patients admitted for a period of 31days (June 01 to July 01, 2015) until hospital discharge. Epidemiological and clinical data were collected daily until ICU discharge, as was the incidence of PU, either new or present on admission. SETTING: 10 general adult ICUs. RESULTS: We evaluated 332 patients, 52.1% male, mean age 63.1 years. The most common cause of admission was medical diseases (50.3%), and the mean APACHE II score was 14.9. A total of 45 patients (13.6%) had PU; the most common sites were sacral, calcaneal, ears, and trochanter. The incidence of PU was related to predictive factors, such as the Braden Scale and length of lack of nutrition. The presence of PU was strongly related to unfavorable outcomes, such as Mechanical Ventilation (MV) duration and ICU and hospital mortality. CONCLUSIONS: PU incidence is related to severity of the patient's condition and predicted by Braden Scale score. The presence of PU is also related to adverse outcomes, such as MV duration and ICU and hospital mortality. It was also shown that patients with PU have a higher incidence of medical complications, such as acute renal failure, pneumonia, and the need for vasoactive drugs.

Serum metalloproteinases 2 and 9 as predictors of gait status, pressure ulcer and mortality after hip fracture.

INTRODUCTION: The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture. METHODS: Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient's admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded. RESULTS: Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture. CONCLUSIONS: In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture.

Ulcera por presion y estado nutricional en el paciente grave en el Hospital Naval / Ulcerates for presion and nutritious state in the serious patient in the Naval Hospital

El costo de una ulcera por presión en las UTI es elevado, tanto desde el punto de vista de recursos como asistencial. Dada esta problemática decidimos realizar una investigación que nos permitiera relacionar la aparición de ulceras por presión con el estado nutricional del paciente grave. Describir la frecuencia de aparición de ulceras por presión. Clasificarlas según la localización topográfica, e identificar mortalidad de estos pacientes. Realizamos un estudio prospectivo, descriptivo en 80 pacientes que ingresaron en una UTI de Adultos. El 23 por ciento de los pacientes comprendidos en el grupo de buen estado nutricional presentó ulcera por presión, con estado nutricional moderado el 40 por ciento y con riesgo de desnutrición un 66 por ciento. Podemos concluir que el deterioro del estado nutricional influye en la aparición de úlceras por presión. Los grupos de pacientes más vulnerables a presentar úlceras por presión fueron los pacientes mayores de 65 años y con una estadía mayor de 20 días. El sexo no influyó en la aparición de dicha lesión. En nuestro estudio la localización de las úlceras fue más frecuente en la región sacra y la glútea. La presencia de úlceras no estuvo relacionada directamente con la mortalidad (AU)