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Journal of Wound Care Sep 2023
Topics: Humans; Pressure Ulcer
PubMed: 37682789
DOI: 10.12968/jowc.2023.32.9.529 -
Critical Care Nursing Clinics of North... Dec 2020Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide... (Review)
Review
Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide appropriate dressing and treatment selection. The interprofessional team, patient, and family should collaborate to create a plan of care for wound healing.
Topics: Bandages; Exudates and Transudates; Humans; Patient Care Team; Practice Guidelines as Topic; Pressure Ulcer; Wound Healing
PubMed: 33129410
DOI: 10.1016/j.cnc.2020.08.002 -
Revista Da Escola de Enfermagem Da U S P 2023Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. (Review)
Review
OBJECTIVE
Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.
METHOD
Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.
RESULTS
15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.
CONCLUSION
Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.
Topics: Humans; Pressure Ulcer; Systematic Reviews as Topic
PubMed: 38133528
DOI: 10.1590/1980-220X-REEUSP-2023-0039en -
Advances in Skin & Wound Care Sep 2023To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries. (Review)
Review
GENERAL PURPOSE
To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries.
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates.
Topics: Humans; Pressure Ulcer; Crush Injuries; Education, Continuing; Nurse Practitioners; Physicians
PubMed: 37603315
DOI: 10.1097/ASW.0000000000000025 -
Journal of Wound Care Sep 2020
Topics: Body Temperature; COVID-19; Coronavirus Infections; Humans; Infrared Rays; Pandemics; Pneumonia, Viral; Pressure Ulcer; Thermography
PubMed: 32924820
DOI: 10.12968/jowc.2020.29.9.483 -
Journal of Tissue Viability Feb 2020Negative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action...
AIM OF THE STUDY
Negative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action remains controversial. Recent evidence suggests an increased tissue pressure and a temporary decreased microvascular blood flow as the main reasons for the good clinical results [1]. In an attempt to further explain the mechanism of action, we investigated the pressure distribution on the foam interface, and the influence on perfusion in a pre-experimental design.
MATERIALS AND METHODS
Pressure distribution was measured using a sensor based on a capacitive dielectric elastomer with flexible electrodes. In vitro flow measurements were done with vessel imitations in a block of 300 bloom ballistic gel to simulate soft tissue.
RESULTS
A peak pressure of up to 187 mmHg (255 g/cm2) within the foam interface, as well as decreased perfusion, were found using a standard negative pressure wound therapy setup. In conclusion, negative pressure wound therapy applies positive pressure to adjacent tissue and decreases local flow. The amount of suction applied is proportional to the pressure on the foam interface and reduction in flow.
CONCLUSION
In line with previous studies investigating the underlying mechanism of action, these findings may contribute to possible alterations in the use of negative pressure wound therapy, e.g. lowering suction pressure in patients with diminished peripheral blood flow.
Topics: Biomechanical Phenomena; Humans; Negative-Pressure Wound Therapy; Pressure; Pressure Ulcer; Regional Blood Flow; Wound Healing
PubMed: 31899070
DOI: 10.1016/j.jtv.2019.12.004 -
AORN Journal Jul 2023Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and...
Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.
Topics: Child; Humans; Pressure Ulcer; Perioperative Period; Practice Guidelines as Topic
PubMed: 37368530
DOI: 10.1002/aorn.13948 -
ACS Biomaterials Science & Engineering Jul 2022Pressure injuries/pressure ulcers (PIs/PUs) are a critical global healthcare issue and represent a considerable burden on healthcare resources. Prevention of PIs/PUs is...
Pressure injuries/pressure ulcers (PIs/PUs) are a critical global healthcare issue and represent a considerable burden on healthcare resources. Prevention of PIs/PUs is the least costly approach and minimizes the patient suffering compared with treatment. Besides, sustained tissue load alleviation and microenvironment management are the most crucial properties for dressings in PI/PU prevention. Hydrogel dressings have attracted a lot of attention to prevent PIs/PUs because of their unique mechanical properties and ability to manage the microenvironment of skin. However, auxiliary prophylaxis and early treatment of PIs/PUs remain a challenge and an acute clinical demand. Here, we report on an electroactive hydrogel with large stretchability (∼380%) and skinlike ductility, and Young's modulus (0.48 ± 0.03 MPa) matches that of human skin (0.5-1.95 MPa). The hydrogel displayed piezoelectric properties and mechanical-electric response stability and sensitivity. Our results indicated that the hydrogel was able to promote in vitro angiogenesis under piezoelectric stimulation and exhibited biocompatibility, which has the potential for forming fine vessels at the damaged sites of PIs/PUs. Furthermore, finite element analysis and pressure dispersion experiments demonstrated that the hydrogel was suitable for preventing PIs/PUs by redistributing force, reducing tissue distortion, and maintaining the microenvironment for skin. This work offers a new strategy for designing and evaluating the dressing for prophylaxis and the early treatment of PIs/PUs.
Topics: Bandages; Humans; Hydrogels; Pressure Ulcer; Suppuration
PubMed: 35767822
DOI: 10.1021/acsbiomaterials.2c00448 -
Inquiry : a Journal of Medical Care... 2021We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four... (Review)
Review
We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm's effectiveness, we compared the incidence of medical device-related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device-related pressure injuries in this population.
Topics: Algorithms; Humans; Incidence; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 34672226
DOI: 10.1177/00469580211050219 -
Advances in Skin & Wound Care Apr 2022The authors identify and synthesize the published primary literature on unavoidable skin breakdown and end-of-life wounds known as terminal ulcers. (Review)
Review
OBJECTIVE
The authors identify and synthesize the published primary literature on unavoidable skin breakdown and end-of-life wounds known as terminal ulcers.
DATA SOURCES
Sources were identified through a systematic search of the Cochrane Library, Medline, ProQuest, EMBASE, CINAHL complete, and PubMed databases.
STUDY SELECTION
The date limiters were set between 1984 and 2020 to locate primary qualitative, quantitative, and/or mixed-methods studies on terminal ulcers.
DATA EXTRACTION
Investigators examined 180 sources and ultimately included four quantitative studies in this review. All were conducted in the US and published between 1989 and 2019. Retrospective chart audits of deceased patients' medical files were undertaken in three of the studies, and prospective observations were used in the fourth.
DATA SYNTHESIS
Descriptive and inductive content analyses were conducted. Three categories emerged: (1) distinguishing the ulcer development patterns, (2) identifying the ulcer characteristics, and (3) delivering specialized and individualized end-of-life care.
CONCLUSIONS
Limited primary evidence has been published on terminal ulcers. Pressure injuries and terminal ulcers have similar appearances, but their development differs significantly. The lack of a specific terminal ulcer assessment tool and staging system increases the risk of these unavoidable end-of-life wounds being incorrectly assessed and managed as pressure injuries. Further research on terminal ulcers is needed to inform clinical practice and ensure specialized care is delivered to patients who develop these wounds.
Topics: Adult; Death; Humans; Pressure Ulcer; Prospective Studies; Retrospective Studies; Ulcer
PubMed: 34693923
DOI: 10.1097/01.ASW.0000798032.98853.95