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Original Articles
Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study
Rev Bras Ter Intensiva. 2017;29(1):39-46
Abstract
Original ArticlesReducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study
Rev Bras Ter Intensiva. 2017;29(1):39-46
DOI 10.5935/0103-507X.20170007
Views1ABSTRACT
Objective:
To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients.
Methods:
This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A “Process Improvement” team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a “family prevention bundle”.
Results:
Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 – 5] days in the Pre-I group and 9 [6 – 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor.
Conclusion:
A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.
Keywords:Intensive care unitsLength of stayMobile applications/standardsPressure ulcer/prevention & controlRespiration, artificialSmartphoneTelemedicine/methodsSee more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis