Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

BACKGROUND Patients in neurology intensive care units(ICU)are prone to pressure injuries(PU)due to factors such as severe illness,long-term bed rest,and physiological dysfunction.PU not only causes pain and complications to patients,but also increases medical burden,prolongs hospitalization time,and affects the recovery process.AIM To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.METHODS A retrospective study was conducted,and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission,with 30 people in each group.The observation group implemented pressure injury prevention and nursing measures,while the control group adopted routine care.RESULTS Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h(8.3%vs 26.7%),7 d(16.7%vs 43.3%),and 14 d(20.0%vs 50.0%).This suggests a substantial reduction in pressure injury incidence in the observation group,with the gap widening over time.Additionally,patients in the observation group exhibited quicker recovery,with a shorter average time to get out of bed(48 h vs 72 h)and a shorter average length of stay(12 d vs 15 d)compared to the control group.Furthermore,post-intervention,patients in the observation group reported significantly improved quality of life scores,including higher scores in body satisfaction,feeling and function,and comfort(both psychological and physiological),indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.CONCLUSION Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

《A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)》解读

2019年国际专家团基于Delphi方法的反复调查和现场讨论,完成了"A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)"(简称"共识"),旨在引导对仅行颅内压监测的颅脑创伤患者实施合理的分级管理。本文对"共识"所涉及的"三阶梯颅内压管理流程"、各级治疗措施的应用原则,以及镇静治疗和颅内压监测停撤的判断流程进行解读,以期将国际颅脑创伤神经重症研究进展介绍给读者。

Driving pressure in mechanical ventilation:A review

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system

The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.

Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.

Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target

The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.

Effects of ambient pressure on the severity of blast injury in rats

The effects of different ambient pressures of 53.99,61.33 and 96.60 kPa on theseverity of blast injury were observed in rats.It was found that when the incident shock wavewas 190.40 kPa in its peak pressure and 10 ms in its duration, both the mortality and the severityof lung injury were progressively increased along with the decrease of the ambient pressure.Themortality rate of the rats in the 6th hour after exposure was 0%,25% and 36.8% and the hem-orrhagic area on the lungs was 63.75+69.01,313.50+357.25 and 653.21+652.25 squaremilimeters when the ambient pressure was 96.60,61.33 and 53.99 kPa respectively.In addi-tion, the lung/body index was 0.93+0.21%,1.31+0.65% and 1.50+0.77% respectively.Itis believed that the decrease of the ambient pressure might decrease the tolerance of the rat to theimpact of blast waves to result in higher mortality and more extensive hemorrhage on the lungs.

Study on Influence Factors of Pressure Injury Risk in the Elderly Inpatients with Kidney Disease Based on LASSO Regression

Objective: This paper aims to explore clinical status and related influence factors of pressure injury (PI) in the elderly inpatients with kidney disease, so as to provide reference for the prevention and treatment of PI in the elderly inpatients with kidney disease. Methods: Retrospective collection method is adopted to collect 158 clinical cases of the elderly inpatients with kidney disease aged ≥ 60 in the Nephrology Department, the First Affiliated Hospital of Jinan University from January 2017 to December 2019, and then least absolute shrinkage and selection Operator (LASSO) regression analysis is used to analyze 17 possible influence factors;finally Logistic regression model is established to analyze and screen influence factors of risk. Results: 1) Among 158 elderly inpatients with medium and high risk of PI, the incidence of PI is 20.25%;the most common stage of injury is stage I (42.5%);sacrococcygeal (60%) is the high-risk site of pressure injury. 2) LASSO regression analysis shows that history of present respiratory infection/respiratory failure (β = 1.2714. P < 0.05) and hospitalization time (β = 0.4177. P < 0.05) are independent factors influencing PI risk in the elderly inpatients with kidney disease. Conclusion: The elderly patients with kidney disease and PI risk are the high incidence population of hospital acquired PI;for the elderly inpatients with kidney disease and having respiratory infection history or respiratory failure, prolonged hospitalization will significantly increase the risk of PI. Therefore, targeted preventive and control measures should be taken to reduce the incidence of PI.

Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool(the COMHON Index)

Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.

Dynamic changes in intramedullary pressure 72 hours after spinal cord injury

Intramedullary pressure increases after spinal cord injury, and this can be an important factor for secondary spinal cord injury. Until now there have been no studies of the dynamic changes of intramedullary pressure after spinal cord injury. In this study, telemetry systems were used to observe changes in intramedullary pressure in the 72 hours following spinal cord injury to explore its pathological mechanisms. Spinal cord injury was induced using an aneurysm clip at T10 of the spinal cord of 30 Japanese white rabbits, while another 32 animals were only subjected to laminectomy. The feasibility of this measurement was assessed. Intramedullary pressure was monitored in anesthetized and conscious animals. The dynamic changes of intramedullary pressure after spinal cord injury were divided into three stages: stage I(steep rise) 1–7 hours, stage Ⅱ(steady rise) 8–38 hours, and stage Ⅲ(descending) 39–72 hours. Blood-spinal barrier permeability, edema, hemorrhage, and histological results in the 72 hours following spinal cord injury were evaluated according to intramedullary pressure changes. We found that spinal cord hemorrhage was most severe at 1 hour post-spinal cord injury and then gradually decreased; albumin and aquaporin 4 immunoreactivities first increased and then decreased, peaking at 38 hours. These results confirm that severe bleeding in spinal cord tissue is the main cause of the sharp increase in intramedullary pressure in early spinal cord injury. Spinal cord edema and blood-spinal barrier destruction are important factors influencing intramedullary pressure in stages Ⅱ and Ⅲ of spinal cord injury.

Changes of Nitric Oxide and Its Relationship with Clinical Features,Intracranial Pressure and Outcome in Acute Head Injury

To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.

Reducing intrathecal pressure after traumatic spinal cord injury: a potential clinical target to promote tissue survival

Spinal cord injury （SCI） is an unexpected event that is both devastating and debilitating, resulting in not just motor and sensory loss, but also autonomic dysfunction of the bladder, bowel and sexual organs. Currently, there are no treatments available to improve outcome follow- ing SCI, leaving individuals with permanent and lifelong physical disability. Worldwide it is estimated that more than 500,000 people sustain a SCI each year, with average lifetime cost of paraplegia and quadriplegia estimated at $5 million and $9.5 million respectively. We therefore urgently need effective therapies to improve quality of life following SCI, and this requires a greater understanding of how cell and axonal injury develops after the traumatic event.

The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older

BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.

Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report

BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.

Review on Development of Pressure Injury Prevention Fabric

Pressure injury is a common postoperative complication of wheelchair users. It has a high incidence rate and can induce sepsis and even death. The fabrics that touch patients’ skin directly have a profound impact on their skin surfaces. This review summarizes the research in the last five years on the relationship between pressure injuries and fabrics. Following the preferred reporting items for systematic reviews and meta-analyses(PRISMA) statement, a systematic literature search is conducted in nine databases, including SCI(Web of Science), IEEE, ASTM, Taylor & Francis, ProQuest, Wiley, SpringerLink, PubMed and SAGE. The research objects, experimental equipment and survey results are investigated in this review, in which twenty-four different textiles and seven different test methodologies are involved. The test methodologies include five kinds of performance tests and two kinds of observational studies. Two studies showed that the particular fabric was helpful to reduce the pressure on the skin surface, and twelve studies revealed that the multi-layer fabric with good air permeability, heat dissipation and moisture dissipation was helpful to prevent pressure injury. This review confirms the correlation between the fabric properties and the occurrence of postoperative pressure injury in wheelchair users. Further experiments are needed to reasonably integrate the fabric characteristics of pressure injury prevention into the mass-produced pressure injury prevention clothes for wheelchair users.

Driving pressure decoded:Precision strategies in adult respiratory distress syndrome management

Mechanical ventilation(MV)is an important strategy for improving the survival of patients with respiratory failure.However,MV is associated with aggravation of lung injury,with ventilator-induced lung injury(VILI)becoming a major concern.Thus,ventilation protection strategies have been developed to minimize complications from MV,with the goal of relieving excessive breathing workload,improving gas exchange,and minimizing VILI.By opting for lower tidal volumes,clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli,which can contribute to lung injury.Additionally,other factors play a role in optimizing lung protection during MV,including adequate positive end-expiratory pressure levels,to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.

Driving pressure:A useful tool for reducing postoperative pulmonary complications

The operating room is a unique environment where surgery exposes patients to non-physiological changes that can compromise lung mechanics.Therefore,raising clinicians’awareness of the potential risk of ventilator-induced lung injury(VILI)is mandatory.Driving pressure is a useful tool for reducing lung complications in patients with acute respiratory distress syndrome and those undergoing elective surgery.Driving pressure has been most extensively studied in the context of single-lung ventilation during thoracic surgery.However,the awareness of association of VILI risk and patient positioning(prone,beach-chair,parkbench)and type of surgery must be raised.

The effects of slight atmospheric pressure fluctuations on the occurrence of emergency transport due to suicidal injuries

The objective of this study was to test the hypothesis that a relation exists between slight atmospheric pressure fluctuations (APF) in the far infrasound frequency range and daily number of emergency transport events due to suicidal injuries (EESU). The regression models to compare groups were used to assess the relation of EESU to the mean daily amplitude of APF (APF-A) and to the ratio of APF amplitude averaged over the daytime to the APF amplitude averaged over the nighttime (Rdn). To eliminate the confounding effects of basic meteorological parameters and annual trend in EESU, the non- parametric smoothing method was used in a stepwise manner. The low APF-A (95% CI = 1.06- 1.16 Pa) compared to their common middle levels and the high (95% CI = 3.18-3.64 Pa), as well the low Rdn (СI = 0.83-0.92) and very high Rdn (CI = 3.05-3.77) compared to their more closed to common regular values (СI = 1.69-1.90) turned out to be more beneficial factors promoting the decrease in the incidence of EESU. We suppose that more attention needs to be paid to the meteorotropic effects of APF on certain kinds of psychopathology resulting in suicidal behaviour, and further investigations in different geograph- ical and climatic conditions, especially in those with more intense atmospheric perturbations, are necessary.

Physicians Attitude towards Pressure Injury Prevention and Management

Background: Cancer and its management can cause cachexia, which, along with prolonged immobility could lead to the development of chronic pressure ulcers (PU). These complications result into infection and/or pressure injury. Though pressure injury related tasks, are deemed to be given to staff nurses alone. Little of literature is available on the physician’s attitude towards PU prevention and management. Medical interns in 2015 concluded that 70% of them need more education in pressure injury. Present study is about physicians involved in pressure injury identification and management in a Cancer Center. Material and methods: A cross-sectional study was conducted in King Fahad Medical City among oncology physicians using self-administered 11 statement survey questionnaire. Physician residents, fellows, assistant consultants’ and consultants’ attitudes were compared. Statistical analyses were performed using SPSS. Results: In total 50 physicians completed the survey. The physicians demonstrated a positive attitude with an average mean score of 42.35 ± 4.65 (32, 51). The difference in the attitude scores among sub-groups was not statistically significant. Conclusions: Our study demonstrated a positive attitude towards pressure ulcer prevention and management among physicians working in Cancer Center. We have also highlighted the challenges in maintaining this positive attitude and possible strategies for improvement in the future.

Risk Factors for Intraoperative Pressure Injury in Aortic Surgery:A Nested Case-Control Study

Aims and Objectives:The aim of this study was to identify risk factors associated with an increased risk of intraoperative pressure injury in patients undergoing aortic surgery.Background:Intraoperative pressure injuries are some of the most signifi cant health problems in clinical practice.According to previous studies,patients undergoing aortic surgery are at high risk of developing an intraoperative pressure injury,with an incidence much higher than that associated with other types of cardiac surgery.Design:This was a nested case-control study.Methods:Following the STROBE checklist,a nested case-control approach was adopted in this study.A patient cohort was selected on the basis of inclusion and exclusion criteria from patients undergoing aortic surgery.Data were collected from these patients by means of a tailored questionnaire designed in-house.Patients with intraoperative pressure injury at the end of surgery were identifi ed as the case group,while the control group consisted of patients without intraoperative pressure injury.Patients in the groups underwent 1:1 matching based on age and sex.Initially,a single-factor analysis was conducted between the two groups.Subsequently,risk factors for intraoperative pressure injury were identifi ed through conditional logistic regression analysis with use of the variables that exhibited statistically signifi cant differences in the single-factor analysis.Results:A total of 400 patients were selected.Among these,167 patients experienced intraoperative pressure injury at an incidence rate of 41.8%.Strict preoperative bed confi nement,deep hypothermic circulatory arrest during surgery,application of norepinephrine or dopamine during surgery,and intraoperative skin wetting were associated with the occurrence of intraoperative pressure injury in patients undergoing aortic surgery.Conclusions:Nurses should thoroughly assess the risk of intraoperative pressure injury and implement appropriate preventative interventions,particularly in high-risk patients undergoing aortic surgery.