背景:俯卧定位已被广泛用于改善重度COVID-19急性呼吸窘迫综合征(ARDS)患者的氧合并减少呼吸机引起的肺损伤。与俯卧位相关的一个主要并发症是压力性溃疡(PU)的发展。
目的:本研究旨在确定在重症监护病房进行俯卧位的COVID-19ARDS患者中,预防性护理对PU发生率的影响。
方法:这是一项单中心测试前和测试后干预研究,符合报告实施研究标准(StaRI)指南。干预措施包括解决以下问题的护理包:增加头部转动的频率,使用开放式凝胶头环,预防性敷料应用于骨骼突出,使用压力再分配气垫,通过定期和严格的皮肤检查以及与护理和医务人员进行床边培训课程,对工作人员进行早期识别不断发展的PU的教育。感兴趣的主要结果是PU发展的发生率。感兴趣的次要结果是PU发育的严重程度和PU的解剖位置。
结果:在干预前研究中,包括20例患者,这些患者中有80%(n=16)发展为PU,总共包括34个溃疡。在干预后研究中,另外20名患者被纳入,这些患者中有60%(n=12)出现了PU,总共包括32个溃疡。这标志着患PU的患者数量减少了25%,观察到的PU总数减少了6%。II级PU在两个研究组中最普遍(65%,n=22;88%,分别为n=28)。在干预后研究中,III级和深部组织损伤的发生率降低(干预前的6%,n=2III级,6%n=2例深部组织损伤;干预后无III级溃疡,Ⅳ级溃疡,或记录深部组织损伤)。然而,在干预后的组中,不可停滞的PU数量有所增加,有6%(n=2)的PU被归类为不可停滞,同时,在干预前的组没有不可停滞的PU.这是一个需要考虑的重要发现,因为无法分级的PU可以指示深部组织损伤,因此需要与更严重等级的PU一起考虑(III级,四级,和深层组织损伤)。
结论:在俯卧位患者的管理中使用新的循证护理束预防PU有可能降低PU的发生率。尽管在对标准实践进行更改后观察到了改进,需要进一步的研究来验证这些发现.
结论:使用新的,在俯卧位患者的管理中,循证护理集束有可能降低PU的发生率。
Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs).
This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit.
This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs.
In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries).
The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings.
The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.