目的:本研究的目的是双重的:描述COVID-19大流行期间ICU患者压疮(PU)的患病率和发生率,并确定ICU患者队列中与PU发展相关的危险因素。
方法:3月1日在两个不同国家(瑞典和葡萄牙)的两个普通ICU入院的成人重症监护患者的回顾性队列研究,2020年4月30日,2021年,通过对电子健康记录数据库的分析。计算患病率和发病率,并使用多变量逻辑回归模型来计算比值比(OR),PU发展的可能风险因素。
结果:样本包括1717名患者。PU的总体患病率为15.3%,ICU获得性PU的发生率为14.1%。在这项研究中记录的大多数压力性溃疡在身体的前部(45.35%)和关于分类,2类(38.40%)和3类(22.71%)压力性溃疡合计占记录病例的50%以上。在PU的多元逻辑回归模型中,年龄,患有COVID-19(OR=1.58,95%CI:1.20-2.09),使用机械通气(OR=1.49,95%CI:1.13=1.97),使用血管升压药(OR=1.31,95%CI:1.00-1.70),入院时Braden风险评分≤16(OR=1.63;95%CI:1.04-2.56),和住院时间(LOS)(OR=1.43,95%CI1.03-2.00,如果LOS90-260h,OR=2.34,95%CI:1.63-3.35,如果LOS>260小时)与发生ICU获得性PU的可能性相关。
结论:当校正协变量后,与没有COVID-19的患者相比,COVID-19患者在ICU住院期间发生PU的风险更高。ICU的医护人员可能会考虑纳入COVID-19,年龄,使用机械通气,除了全面的风险评估,包括风险评分和临床评估,血管加压药和估计的LOS。
OBJECTIVE: The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients.
METHODS: Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development.
RESULTS: The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs.
CONCLUSIONS: When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.