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1.
Estima (Online) ; 19(1): e0521, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1178332

RESUMO

Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.


Assuntos
Infecções por Coronavirus , Lesão por Pressão , Unidades de Terapia Intensiva , Cuidados de Enfermagem
2.
Estima (Online) ; 19(1): e1021, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1280950

RESUMO

Objetivo:identificar e descrever os fatores de risco para desenvolvimento de lesão por pressão em pacientes oncológicos adultos e as intervenções preventivas interdisciplinares. Método: revisão integrativa da literatura. A coleta de dados foi realizada no período de março e abril de 2019 e dezembro de 2020, utilizando as bases de dados: BDENF; PubMed/Medline; Embase; Scopus; Cinahal e Web of Science. Resultados: a amostra foi composta por 16 artigos publicados no período de 2008 a 2019. Dentre os fatores de risco identificados destacam-se: situação nutricional, idade avançada, incontinência e imobilidade; as intervenções preventivas interdisciplinares identificadas foram: mudança de decúbito, avaliação e acompanhamento nutricional, cuidados com a pele e uso de superfícies de suporte. Conclusão: há necessidade de mais estudos para um olhar cuidadoso e assertivo para os pacientes oncológicos.


Objective:identify and describe the risk factors for the development of pressure injuries in adult cancer patients and interdisciplinary preventive interventions. Method: integrative literature review. Data collection was carried out between March and April 2019 and December 2020, using the databases: BDENF; PubMed/Medline; Embase; Scopus; Cinahal and Web of Science. Results: the sample consisted of 16 articles published from 2008 to 2019. Among the risk factors identified, the following stand out: nutritional status, advanced age, incontinence and immobility; the interdisciplinary preventive interventions identified were: decubitus change, nutritional assessment and monitoring, skin care and use of support surfaces. Conclusion: further studies are needed to take a careful and assertive look at cancer patients.


Assuntos
Equipe de Assistência ao Paciente , Fatores de Risco , Lesão por Pressão , Oncologia
3.
Estima (Online) ; 19(1): e1121, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1280951

RESUMO

Objetivos:identificar a incidência e caracterizar as lesões por pressão em unidade de terapia intensiva adulta quanto à ocorrência, locais e fatores de risco, e verificar se há associação entre esses e o surgimento das lesões. Método: estudo observacional, coorte, prospectivo, desenvolvido em unidade de terapia intensiva de hospital terciário, de outubro a dezembro de 2019. A população constitui-se de adultos em primeiro dia de internação na unidade, sem lesão por pressão na admissão. Os participantes foram acompanhados durante a internação e variáveis sociodemográficas e clínicas, assim como avaliação do risco de desenvolver lesão por pressão, avaliação da pele e escala de Braden foram coletadas diariamente. Empregaram-se testes de Qui-quadrado de Pearsone teste t de student para avaliar as relações entre variáveis e lesões. Para as análises foi considerado nível de significância (α) de 5%. Resultados: foram incluídos 40 participantes, 20% apresentaram lesão por pressão com predominância dos estágios 1 e 2; os principais locais afetados foram a região sacral seguida pelo calcâneo. O tempo médio de internação foi 23,38 dias para o grupo com lesão e 5,77 dias para o grupo sem lesão; o tempo apresentou relação significativa com o surgimento das lesões (p=0,002). Conclusão: conclui-se que o local mais acometido foi a região sacral e grau 1 o estadiamento mais frequente; o tempo de internação foi a variável que influenciou o surgimento de lesões.


Objectives:identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson's chi-square tests and student's t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results:40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.


Assuntos
Incidência , Fatores de Risco , Enfermagem , Lesão por Pressão , Unidades de Terapia Intensiva
5.
J Int Med Res ; 49(9): 3000605211039820, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34496646

RESUMO

Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers has been rarely reported. A 62-year-old man developed a high fever and dark-colored urine. For the past 30 years, he had lived with paraplegia, which led to his immobility. Physical examination showed evidence of repeated dehiscence and exudation of the wound on his sacrococcygeal region with loss of skin sensation. Upon corroboration of the physical examination findings and laboratory test results, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue and then repaired the chronic ulcer. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine gradually resolved postoperatively. The patient's renal function also improved according to the typical laboratory indicators, and the size of the pressure ulcers decreased to some extent. The patient was discharged after 1 month of hospitalization. This case highlights that accurate diagnosis is critical for administration of precise treatment to paraplegic patients with progressive rhabdomyolysis.


Assuntos
Infecções , Lesão por Pressão , Rabdomiólise , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Lesão por Pressão/complicações , Rabdomiólise/complicações , Região Sacrococcígea
6.
Rev Bras Enferm ; 74(5): e20180686, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34468545

RESUMO

OBJECTIVE: to identify products/technologies for treating patients with pressure ulcers with an evidence level 1. METHOD: this is an integrative literature review. A survey of studies was carried out using the United States National Library of Medicine Portal, Scientific Electronic Library Online, Virtual Health Library, National Library of Medicine(®), The Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean in Health Sciences, Nursing Database. RESULTS: sixteen articles were selected with level of evidence 1. The findings were categorized into five categories: Topical therapy to promote healing; Alternative therapy to promote healing; Topical therapy to promote debridement; Topical therapy to minimize lesion contamination; Topical therapy to reduce lesion size. FINAL CONSIDERATIONS: the 17 products/technologies identified favor/fast healing, debridement, minimize contamination and reduce lesion size to accelerate healing.


Assuntos
Lesão por Pressão , Humanos , Lesão por Pressão/terapia , Tecnologia , Cicatrização
7.
J Wound Ostomy Continence Nurs ; 48(5): 394-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495929

RESUMO

PURPOSE: The purpose of this study was to explore neonatal nursing practices for neonatal pressure injury (PI) risk assessment, pressure redistribution surface use, and moisture management. DESIGN: A descriptive survey. SUBJECT/SETTINGS: A sample of 252 neonatal nurses mainly from the United States responded to a survey distributed electronically through the National Association of Neonatal Nurses, the Academy of Neonatal Nurses, and on the Wound Source Web site. METHODS: Nurses responded to questions that explored what neonatal nurses used to assess PI risk, types of pressure redistribution surfaces used for neonates, and what moisture management strategies were used to prevent PIs. Descriptive statistics were used to describe nurses' practices. RESULTS: When assessing risk, 78% (n = 197/252) reported using a risk assessment scale: the 2 most common scales were the Neonatal Skin Risk Assessment Scale and the Braden Q Scale. Sixty-nine percent (n = 174/252) reported using a rolled blanket or small soft object as pressure redistribution surfaces. In addition, 15% (n = 39) reported the use of different types of positioners such as a fluidized positioner as pressure redistribution surfaces; however, these are marketed as a positioning devices. It appears that these interventions were considered redistribution surfaces by the nurses. For moisture management, petrolatum-based products (6.7%; n = 17/252) and ostomy powders (6%; n = 16/252) were most frequently used. CONCLUSIONS: Practices for PI prevention are different for neonatal patients due to their gestational age, size, and level of illness. Findings from this study create a beginning knowledge of and an opportunity for further research to determine how these practices affect outcomes such as PI incidence and prevalence.


Assuntos
Enfermagem de Cuidados Críticos , Enfermagem Neonatal , Cuidados de Enfermagem , Lesão por Pressão , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Lesão por Pressão/prevenção & controle , Inquéritos e Questionários , Estados Unidos
8.
Cochrane Database Syst Rev ; 8: CD013761, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34398473

RESUMO

BACKGROUND: Pressure ulcers (also known as pressure injuries, pressure sores and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Specific kinds of beds, overlays and mattresses are widely used with the aim of preventing and treating pressure ulcers. OBJECTIVES: To summarise evidence from Cochrane Reviews that assess the effects of beds, overlays and mattresses on reducing the incidence of pressure ulcers and on increasing pressure ulcer healing in any setting and population. To assess the relative effects of different types of beds, overlays and mattresses for reducing the incidence of pressure ulcers and increasing pressure ulcer healing in any setting and population. To cumulatively rank the different treatment options of beds, overlays and mattresses in order of their effectiveness in pressure ulcer prevention and treatment. METHODS: In July 2020, we searched the Cochrane Library. Cochrane Reviews reporting the effectiveness of beds, mattresses or overlays for preventing or treating pressure ulcers were eligible for inclusion in this overview. Two review authors independently screened search results and undertook data extraction and risk of bias assessment using the ROBIS tool. We summarised the reported evidence in an overview of reviews. Where possible, we included the randomised controlled trials from each included review in network meta-analyses. We assessed the relative effectiveness of beds, overlays and mattresses for preventing or treating pressure ulcers and their probabilities of being, comparably, the most effective treatment. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We include six Cochrane Reviews in this overview of reviews, all at low or unclear risk of bias. Pressure ulcer prevention: four reviews (of 68 studies with 18,174 participants) report direct evidence for 27 pairwise comparisons between 12 types of support surface on the following outcomes: pressure ulcer incidence, time to pressure ulcer incidence, patient comfort response, adverse event rates, health-related quality of life, and cost-effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Pressure ulcer incidence: our overview includes direct evidence for 27 comparisons that mostly (19/27) have very low-certainty evidence concerning reduction of pressure ulcer risk. We included 40 studies (12,517 participants; 1298 participants with new ulcers) in a network meta-analysis involving 13 types of intervention. Data informing the network are sparse and this, together with the high risk of bias in most studies informing the network, means most network contrasts (64/78) yield evidence of very low certainty. There is low-certainty evidence that, compared with foam surfaces (reference treatment), reactive air surfaces (e.g. static air overlays) (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.29 to 0.75), alternating pressure (active) air surfaces (e.g. alternating pressure air mattresses, large-celled ripple mattresses) (RR 0.63, 95% CI 0.42 to 0.93), and reactive gel surfaces (e.g. gel pads used on operating tables) (RR 0.47, 95% CI 0.22 to 1.01) may reduce pressure ulcer incidence. The ranking of treatments in terms of effectiveness is also of very low certainty for all interventions. It is unclear which treatment is best for preventing ulceration. (2) Time to pressure ulcer incidence: four reviews had direct evidence on this outcome for seven comparisons. We included 10 studies (7211 participants; 699 participants with new ulcers) evaluating six interventions in a network meta-analysis. Again, data from most network contrasts (13/15) are of very low certainty. There is low-certainty evidence that, compared with foam surfaces (reference treatment), reactive air surfaces may reduce the hazard of developing new pressure ulcers (hazard ratio (HR) 0.20, 95% CI 0.04 to 1.05). The ranking of all support surfaces for preventing pressure ulcers in terms of time to healing is uncertain. (3) Cost-effectiveness: this overview includes direct evidence for three comparisons. For preventing pressure ulcers, alternating pressure air surfaces are probably more cost-effective than foam surfaces (moderate-certainty evidence). Pressure ulcer treatment: two reviews (of 12 studies with 972 participants) report direct evidence for five comparisons on: complete pressure ulcer healing, time to complete pressure ulcer healing, patient comfort response, adverse event rates, and cost-effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Complete pressure ulcer healing: our overview includes direct evidence for five comparisons. There is uncertainty about the relative effects of beds, overlays and mattresses on ulcer healing. The corresponding network meta-analysis (with four studies, 397 participants) had only three direct contrasts and a total of six network contrasts. Again, most network contrasts (5/6) have very low-certainty evidence. There was low-certainty evidence that more people with pressure ulcers may heal completely using reactive air surfaces than using foam surfaces (RR 1.32, 95% CI 0.96 to 1.80). We are uncertain which surfaces have the highest probability of being the most effective (all very low-certainty evidence). (2) Time to complete pressure ulcer healing: this overview includes direct evidence for one comparison: people using reactive air surfaces may be more likely to have healed pressure ulcers compared with those using foam surfaces in long-term care settings (HR 2.66, 95% CI 1.34 to 5.17; low-certainty evidence). (3) Cost-effectiveness: this overview includes direct evidence for one comparison: compared with foam surfaces, reactive air surfaces may cost an extra 26 US dollars for every ulcer-free day in the first year of use in long-term care settings (low-certainty evidence). AUTHORS' CONCLUSIONS: Compared with foam surfaces, reactive air surfaces may reduce pressure ulcer risk and may increase complete ulcer healing. Compared with foam surfaces, alternating pressure air surfaces may reduce pressure ulcer risk and are probably more cost-effective in preventing pressure ulcers. Compared with foam surfaces, reactive gel surfaces may reduce pressure ulcer risk, particularly for people in operating rooms and long-term care settings. There are uncertainties for the relative effectiveness of other support surfaces for preventing and treating pressure ulcers, and their efficacy ranking. More high-quality research is required; for example, for the comparison of reactive air surfaces with alternating pressure air surfaces. Future studies should consider time-to-event outcomes and be designed to minimise any risk of bias.


Assuntos
Roupas de Cama, Mesa e Banho , Leitos , Lesão por Pressão/prevenção & controle , Humanos , Incidência , Metanálise em Rede , Lesão por Pressão/epidemiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Medicine (Baltimore) ; 100(33): e26767, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414933

RESUMO

OBJECTIVE: The aim of this study was to investigate the effect of Ma Yinglong Shexiang Hemorrhoids Cream combined with pearl powder on pain and complications in patients with severe pressure ulcers. METHODS: One hundred seventeen patients with severe pressure ulcers hospitalized and treated in our hospital (January 2019--December 2019) were divided into Ma Yinglong Musk Hemorrhoid Cream Group (MY Group), Pearl Powder Group (PP Group), and combination with Ma Yinglong Musk Hemorrhoid Cream and Pearl Powder Group (MP group), 39 patients in each group. There was no significant difference in the general data of patients in MY group, PP group, and MP group. By analyzing the differences in clinical efficacy, secondary effects, scar incidence, pain, and clinical indicators of patients in the MY group, PP group, and MP group, the effects of Mayinglong Shexiang Hemorrhoid Cream combined with pearl powder in the treatment of pain and complications in patients with severe pressure ulcers were explored. RESULTS: After treatment, compared with the MY group and the PP group, the MP group had a higher clinical efficacy than the MY group and the PP group. Compared with MY group and PP group, the healing time, dressing change times, and dressing change time of MP group were better than MY group (P < .05). After treatment, the VAS score and incidence of secondary effects of the MP group was significantly lower than that of the MY group and PP group (P < .05). The incidence and area of scar formation in the MP group were lower than those in the MY group and the PP group (P < .05). CONCLUSION: Compared with Ma Yinglong Musk Hemorrhoid Cream or Pearl Powder, combination of Ma Yinglong Musk Hemorrhoid Cream and Pearl Powder are more effective in treating severe pressure ulcer patients, and can significantly reduce the pain in the affected area and reduce the occurrence of complications.


Assuntos
Medicina Tradicional Chinesa , Manejo da Dor/métodos , Dor/tratamento farmacológico , Dor/etiologia , Lesão por Pressão/complicações , Adulto , Feminino , Hemorroidas/tratamento farmacológico , Humanos , Masculino , Pomadas , Medição da Dor , Pós , Índice de Gravidade de Doença
10.
Rev Esc Enferm USP ; 55: e20200549, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34423807

RESUMO

OBJECTIVE: To develop nursing diagnoses and care plans for older adults with pressure injuries based on risk factors, aiming at preventing their occurrence in hospitalized older adults. METHOD: Exploratory, descriptive, cross-sectional, quantitative study conducted with 87 medical records at the Medical Clinic Unit of a University Hospital. RESULTS: Among older adults at some risk for the development of pressure injury, there was a prevalence of the female sex, age over 80 years and moderate risk classification on the Braden Scale. Nursing interventions that encourage patient mobility, pressure control, skin supervision, nutrition, incontinence and hygiene stood out. CONCLUSION: Nursing has an important role in maintaining the integrity of patients' skin. It is worth highlighting the use of injury predictive scales as a complement to clinical practice in order to assist in the nursing diagnosis with a view to interventions aimed at risk factors.


Assuntos
Diagnóstico de Enfermagem , Lesão por Pressão , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Lesão por Pressão/diagnóstico , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Prevalência , Fatores de Risco
12.
Br J Nurs ; 30(15): S32-S38, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379458

RESUMO

Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.


Assuntos
Anemia , Lesão por Pressão , Cicatrização , Idoso , Anemia/fisiopatologia , Humanos , Lesão por Pressão/prevenção & controle , Cicatrização/fisiologia
13.
Br J Nurs ; 30(15): S12-S23, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379466

RESUMO

Several studies have demonstrated improved clinical outcomes in pressure ulcer prevention using the SEM scanner, but none have compared it with other methods. In one of Scotland's health boards, 'hot spot' wards had been unable to reduce the number of hospital-acquired pressure ulcers (HAPUs) after several years of focused improvement work. In addition, other wards showed high use of dynamic therapy systems with associated costs. This review compares the use of a first generation SEM scanner versus a mattress and equipment selection pathway over a 6-week period. The findings show that the SEM scanner wards had zero HAPU while the equipment pathway wards developed a total of 4 HAPU. The two SEM scanner wards showed a 11% and 33% reduction in dynamic therapy use, while the pathway wards showed an average 40% increase. Consideration should be given to using SEM scanners to support staff decision-making to reduce HAPU development and dynamic therapy usage.


Assuntos
Microscopia Eletrônica de Varredura , Lesão por Pressão , Leitos , Equipamentos e Provisões , Hospitais , Humanos , Lesão por Pressão/diagnóstico , Lesão por Pressão/prevenção & controle
14.
J Wound Care ; 30(8): 653-659, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34382843

RESUMO

We report the successful treatment of two cases of difficult-to-treat pressure ulcers with botulinum toxin type A (BoNT-A). A 71-year-old male patient with Parkinson's disease presented with severe hand grip deformities of the fingers and a pressure ulcer (PU) on the right hand. He received 240U of BoNT-A into the upper limb muscles, which improved finger mobility during passive extension and resulted in resolution of the palm PU. No recurrence was noted. A 69-year-old female patient with Lewy body dementia presented with a PU on the palm side of the middle finger apex of the right hand, with exposure of the phalanx bone and dark red oedematous granulation of the tip of the finger. Severe muscle tone was noted. She received 240U of BoNT-A injected into the muscles of the upper extremities. This resulted in the disappearance of the contracture between the middle finger cusp and palm, and prompt healing of the PU. A protective finger orthosis was also used to improve hand finger grip and prevent further PUs. Although BoNT-A injection resulted in only slight improvement in the range of motion, it produced relief of pressure with consequent healing of the PU. Injection of BoNT-A into the affected muscles of the patients in this case report was effective in reducing flexor muscle tone, relief of pressure on the palm skin and healing of hand PUs.


Assuntos
Toxinas Botulínicas Tipo A , Lesão por Pressão , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Feminino , Força da Mão , Humanos , Masculino , Espasticidade Muscular , Lesão por Pressão/tratamento farmacológico , Amplitude de Movimento Articular , Resultado do Tratamento
15.
J Wound Care ; 30(8): 632-641, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34382846

RESUMO

OBJECTIVE: This study aimed to evaluate the interface pressure and skin surface temperature in relation to the incidence of pressure injury (PI) using three different turning schedules. METHOD: This was a pilot study with a three-armed randomised clinical trial design. Participants at risk of PI and treated in the high dependency care unit in a regional hospital in Makassar, Indonesia participated in this study. Patients were repositioned at three different turning schedules (two-, three- and four-hourly intervals). Interface pressure measurement and skin surface temperature were measured between 14:00 and 18:00 every three days. The incidence of PI was assessed during the two-week observation period. RESULTS: A total of 44 participants took part in the study. A one-way ANOVA test revealed no difference in interface pressure among the three different turning schedule groups within two weeks of observations: day zero, p=0.56; day four, p=0.95; day seven, p=0.56; day 10, p=0.63; and day 14, p=0.92. Although the average periumbilical temperature and skin surface temperature were not significant (p>0.05), comparison between these observation sites was significant on all observation days (p<0.05). Regarding the incidence of PI, the proportional hazard test for the development of PI in the three groups was considered not different (hazard ratio: 1.46, 95% confidence interval: 0.43-4.87, p=0.54). CONCLUSION: No difference in interface pressure and incidence of PI on the three turning schedules was observed; however, there was a potential increase in skin surface temperature in comparison with periumbilical temperature for all three turning schedules.


Assuntos
Lesão por Pressão , Humanos , Incidência , Projetos Piloto , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Temperatura Cutânea , Temperatura
16.
J Wound Care ; 30(8): 594-597, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34382848

RESUMO

Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.


Assuntos
COVID-19 , Transplante de Pulmão , Lesão por Pressão , Idoso , Humanos , Masculino , SARS-CoV-2 , Retalhos Cirúrgicos
17.
Br J Nurs ; 30(15): S24-S30, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379465

RESUMO

This article provides an introduction to the aetiology of medical device-related pressure ulcers (MDRPUs), describes the vicious cycle that leads to these injuries and highlights bioengineering methodologies and findings that connect the aetiology to the clinical practice of preventing MDRPUs. Specifically, the vicious cycle of MDRPUs is triggered by the sustained tissue deformations induced by a skin-contacting device. The primary, deformation-inflicted cell damage leads to a secondary inflammatory-oedema-related damage and then to tertiary ischaemic damage. Each of these three factors contributes to cumulative cell death and tissue damage under and near the applied device. The damage therefore develops in an escalated manner, as a result of the added contributions of the above three factors. This phenomenon is exemplified through two common clinical scenarios. First, through the use of continuous positive airway pressure (CPAP) masks, which are being applied extensively in the current COVID-19 pandemic, and, second, through the use of doughnut-shaped head positioners, which are applied to surgical patients and sometimes to bedridden individuals who receive intensive care in a supine position. These two medical devices cause intense, localised mechanical loads in the facial skin and underlying tissues (CPAP mask) and at the occipital scalp (doughnut-shaped positioner), where the soft tissues cannot swell in response to the inflammatory oedema as, in both cases, the tissues are sandwiched between the device and the skull. Accordingly, the two device types result in characteristic MDRPUs that are avoidable through appropriate prophylactic interventions, that is, preventive dressings under the CPAP mask and replacement of the doughnut device by a soft, shape-conforming support aid to alleviate and disperse the localised soft tissue deformations. Hence, understanding the aetiology of MDRPUs targets and focuses effective clinical interventions.


Assuntos
Equipamentos e Provisões , Lesão por Pressão , COVID-19/epidemiologia , Equipamentos e Provisões/efeitos adversos , Humanos , Pandemias , Lesão por Pressão/etiologia , Lesão por Pressão/enfermagem
18.
BMC Health Serv Res ; 21(1): 803, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384404

RESUMO

BACKGROUND: Quality improvement (QI) is used in nursing homes (NH) to implement and sustain improvements in patient outcomes. Little is known about how QI strategies are used in NHs. This lack of information is a barrier to replicating successful strategies. Guided by the Framework for Implementation Research, the purpose of this study was to map-out the use, evaluation, and reporting of QI strategies in NHs. METHODS: This scoping review was completed to identify reports published between July 2003 through February 2019. Two reviewers screened articles and included those with (1) the term "quality improvement" to describe their methods, or reported use of a QI model (e.g., Six Sigma) or strategy (e.g., process mapping) (2), findings related to impact on service and/or resident outcomes, and (3) two or more NHs included. Reviewers extracted data on study design, setting, population, problem, solution to address problem, QI strategies, and outcomes (implementation, service, and resident). Vote counting and narrative synthesis were used to describe the use of QI strategies, implementation outcomes, and service and/or resident outcomes. RESULTS: Of 2302 articles identified, the full text of 77 articles reporting on 59 studies were included. Studies focused on 23 clinical problems, most commonly pressure ulcers, falls, and pain. Studies used an average of 6 to 7 QI strategies. The rate that strategies were used varied substantially, e.g., the rate of in-person training (55%) was more than twice the rate of plan-do-study-act cycles (20%). On average, studies assessed two implementation outcomes; the rate these outcomes were used varied widely, with 37% reporting on staff perceptions (e.g., feasibility) of solutions or QI strategies vs. 8% reporting on fidelity and sustainment. Most studies (n = 49) reported service outcomes and over half (n = 34) reported resident outcomes. In studies with statistical tests of improvement, service outcomes improved more often than resident outcomes. CONCLUSIONS: This study maps-out the scope of published, peer-reviewed studies of QI in NHs. The findings suggest preliminary guidance for future studies designed to promote the replication and synthesis of promising solutions. The findings also suggest strategies to refine procedures for more effective improvement work in NHs.


Assuntos
Lesão por Pressão , Melhoria de Qualidade , Acidentes por Quedas/prevenção & controle , Humanos , Casas de Saúde , Gestão da Qualidade Total
19.
Rev Esc Enferm USP ; 55: e20200397, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34435611

RESUMO

OBJECTIVE: To determine the prevalence of medical device-related pressure injuries in critical patients and analyze the associated factors. METHOD: Epidemiological, cross-sectional study. Sociodemographic, clinical and medical device data were collected. Inspection of the skin/mucous membranes was performed to identify and classify the injuries. Analysis using descriptive statistics, Poisson regression and the Spearman correlation coefficient. RESULTS: Ninety-three patients were evaluated and 58 developed injuries, with a prevalence of 62.4%. Injuries by the orotracheal tube (50%), nasogastric tube (44.1%) and urinary catheter (28.6%) were the most prevalent, and the most affected regions were, respectively, the auricular (79.5%), nasal ala (86.7%) and urethral meatus (76.9%). Factors associated with injuries were severe edema (p = 0.005), low Braden (p<0.001) and Glasgow (p = 0.008) scores, length of stay in intensive care (p<0.001) and hospitalization diagnosis classified as other causes (p<0.001). The use of more than one device (p<0.001) and a longer time of use (p<0.001) were correlated. CONCLUSION: The high prevalence of injuries and the associated factors indicate the need for preventive measures and risk monitoring.


Assuntos
Lesão por Pressão , Cuidados Críticos , Estudos Transversais , Humanos , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Prevalência , Fatores de Risco
20.
Sensors (Basel) ; 21(13)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34202252

RESUMO

Pressure injury (PI) is a major problem for patients that are bound to a wheelchair or bed, such as seniors or people with spinal cord injuries. This condition can be life threatening in its later stages. It can be very costly to the healthcare system as well. Fortunately with proper monitoring and assessment, PI development can be prevented. The major factor that causes PI is prolonged interface pressure between the body and the support surface. A possible solution to reduce the chance of developing PI is changing the patient's in-bed pose at appropriate times. Monitoring in-bed pressure can help healthcare providers to locate high-pressure areas, and remove or minimize pressure on those regions. The current clinical method of interface pressure monitoring is limited by periodic snapshot assessments, without longitudinal measurements and analysis. In this paper we propose a pressure signal analysis pipeline to automatically eliminate external artefacts from pressure data, estimate a person's pose, and locate and track high-risk regions over time so that necessary attention can be provided.


Assuntos
Lesão por Pressão , Traumatismos da Medula Espinal , Cadeiras de Rodas , Humanos
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