Early Detection Methods of Deep Tissue Pressure Injuries:A Systematic Review

Deep tissue pressure injuries(DTPIs)have witnessed a growing prevalence in hospitals and other health care units especially among individuals with pathological conditions that give rise to restricted mobility,impaired sensation,and reduced tissue tolerance.The etiology of DTPIs has been a subject of controversy,to which several explanatory models have been proposed,including direct mechanical insult,ischemia-reperfusion,lymphatic occlusion,and inflammatory cytokines.In line with these pathophysiological scenarios,ultrasound,subepidermal moisture detection,and biomarker technologies have been proposed as potential early detection methods of DTPIs.This paper provides a systematic review involving these three methods.The conclusion is that combining and implementing these methods at different time periods during DTPIs development and progression respectively is likely to be the most universal,effective and promising way for DTPIs diagnosis.

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.

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.

Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis

Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.

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.

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.

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.

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.

Does high intraocular pressure exclude an open globe injury?

Dear Sir,Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable diagnostic and management strategies for open-globe injuries[1].Amongst many types of ocular trauma,the open globe injury is the most serious due to its very poor visual prognosis and young population of patients are mostly affected[2].The treatment outcome may be improved by prompt diagnosis,and immediate surgical repair performed to high standard[3].Amongst the other clinical signs the intraocular pressure(IOP)is found to be particularly reduced and conventionally this is considered as a very reliable indicator of occult globe

Risk Analysis of Risk Factors for Pressure Injury Related to Tracheal Intubation in ICU Patients

Objective:This article mainly analyzes the risk factors of pressure injury related to tracheal intubation in ICU patients.Methods:This time,the investigation and research were mainly conducted on 110 patients with tracheal intubation received in the ICU of our hospital from June 2020 to June 2021,and the risk factors for related pressure injuries were analyzed.Results:According to statistics,the incidence rate of patients with tracheal intubation-related pressure injury was 23.63%,of which the lip had the highest incidence;the indwelling time of the tracheal tube,the wetness score,the movement force score,and the frictional shear score in the Braden score of the tracheal intubation These are all risk factors for pressure injury related to tracheal intubation(P<0.05).Conclusion:ICU patients have a higher incidence of related pressure injuries during tracheal intubation,so it is necessary to strengthen the care of risk factors and take reasonable and effective measures to prevent them.

Clinical significance of large decompressive craniectomy to control intractable increased intracranial pressure in patients with traumatic brain injury

Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and the time window of DC to affect on prognosis. Methods The clinical record of 132 patients who underwent DC for posttraumatic intractable ICH in our hospital from July 2003 to

The Effect of Plasma Jet on Bacterial Species and Correlation with Physiotherapy

Introduction: As representatives of prokaryotic beings, bacteria were selected in nature for their very high capacity to adapt to the environment. The human body comprises a vast population of bacteria needed for health maintenance;skin lesions represent a major public health problem involving the nutritional, hospital and illness of the patient. Objective: The objective of this study was to verify the effect of the plasma jet on bacterial species and to correlate it with clinical physiotherapy. Method: This is an in vitro experimental study carried out at FSG University Center. Performed through cultures of bacteria Sthaphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae under the effect of plasma jet. Results: As observed all strains were resistant to penicillin, creating no inhibition halo in any of them. In the plates of the bacteria Staphylococcus aureus, in the area where the Plasma Jet was applied there was no microbial growth. In Klebsiella pneumoniae strains microbial growth was achieved in 90 and 120 seconds. Finally, Pseudomonas aeruginosa plates in the 90 seconds were microbial growth compared to the 120 and 180 seconds. Conclusion: It can be concluded that the time of application of the plasma jet has an important role in the antimicrobial action, when compared to Physiotherapy, a new method of treatment for skin lesions may be an option, with the aim of reducing infections and accelerating the process of tissue healing.

Stability of rat models of fluid percussion-induced traumatic brain injury: comparison of three different impact forces

Fluid percussion-induced traumatic brain injury models have been widely used in experimental research for years. In an experiment, the stability of impaction is inevitably affected by factors such as the appearance of liquid spikes. Management of impact pressure is a crucial factor that determines the stability of these models, and direction of impact control is another basic element. To improve experimental stability, we calculated a pressure curve by generating repeated impacts using a fluid percussion device at different pendulum angles. A stereotactic frame was used to control the direction of impact. We produced stable and reproducible models, including mild, moderate, and severe traumatic brain injury, using the MODEL01-B device at pendulum angles of 6°, 11° and 13°, with corresponding impact force values of 1.0 ± 0.11 atm（101.32 ± 11.16 k Pa）, 2.6 ± 0.16 atm（263.44 ± 16.21 k Pa）, and 3.6 ± 0.16 atm（364.77 ± 16.21 k Pa）, respectively. Behavioral tests, hematoxylin-eosin staining, and magnetic resonance imaging revealed that models for different degrees of injury were consistent with the clinical properties of mild, moderate, and severe craniocerebral injuries. Using this method, we established fluid percussion models for different degrees of injury and stabilized pathological features based on precise power and direction control.

Analysis of the Risks of Development Injury Related to Surgical Positioning in a University Hospital of the State of Goiás/Brazil: An Observational-Epidemiological Study

Introduction: The perioperative nurse plays an important role throughout the surgical period, especially in the context of predicting the risks to which patients are exposed when entering a surgical center. These can be skin, muscle, tendon, and even burn injuries from the scalpel or chemicals. Objective: The aim of this study was to verify the degree of risk for the development of injuries resulting from surgical positioning in patients of a university hospital. Methods: This is cross-sectional, exploratory research with a quantitative approach conducted with 70 surgical patients in a Municipal University Hospital with data collection through a socioeconomic and health questionnaire and the Risk Assessment Scale for Development of Surgical Positioning Injuries (SISP). Statistical analyses included simple descriptive evaluation, correlations of variables using the Chi-square test and Pearson’s coefficient with a significance level of 5%. Results: The results found pointed to a population mainly composed of women (60%), married, with an average age of 49 years, with hypertension and high-risk scores to develop injuries due to surgical positioning. There was also a positive and significant correlation between having hypertension and having a higher risk of developing lesions, with R2 = 96.4% and p < 0.05. Conclusion: The results reinforce the need to implement protocols and the acquisition of materials aimed at reducing the risk of injuries related to surgical positioning in order to improve the quality of care offered and thus minimize the harm to users.

dECM restores macrophage immune homeostasis and alleviates iron overload to promote DTPI healing

Due to its highly insidious and rapid progression,deep tissue pressure injury(DTPI)is a clinical challenge.Our previous study found that DTPI may be a skeletal muscle injury dominated by macrophage immune dysfunction due to excessive iron accu-mulation.Decellularized extracellular matrix(dECM)hydrogel promotes skeletal muscle injury repair.However,its role in po-larizing macrophages and regulating iron metabolism in DTPI remains unclear.Here,porcine dECM hydrogel was prepared,and its therapeutic function and mechanism in repairing DTPI were investigated.The stimulus of dECM hydrogel toward RAW264.7 cells resulted in a significantly higher percentage of CD2o6+macrophages and notably decreased intracellular divalent iron levels.In mice DTPI model,dECM hydrogel treatment promoted M1 to M2 macrophage conversion,improved iron metabolism and reduced oxidative stress in the early stage of DTPI.In the remodeling phase,the dECM hydrogel remarkably enhanced revascularization and accelerated skeletal muscle repair.Furthermore,the immunomodulation of dEcM hydrogels in vivo was mainly involved in the P13k/Akt signaling pathway,as revealed by GO and KEGG pathway analysis,which may ameliorate the iron deposition and promote the healing of DTPI.Our findings indicate that dECM hydrogel is promising in skeletal muscle repair,inflammation resolution and tissue injury healing by effectively restoring macrophage immune homeostasis and normalizing iron metabolism.

High pressure paint gun injury of the index finger:a case report

Injuries to the hand secondary to high pressure paint guns are considered to be true hand emergencies.These rare injuries may have serious outcomes,and a critical step in their management is extensive debridement performed within the first six hours following injury.For this reason,their diagnosis should not be delayed,and the hand surgeon should be informed immediately to initiate appropriate treatment.In this report,the authors describe a patient who was injured with a chemical paint gun,and whose injury was not diagnosed in the emergency department.The patient subsequently developed tenosynovitis.His treatment is reported herein.