Preventing pressure injuries among patients in the intensive care unit: insights gained
Fiona Coyer, Sonia Labeau, Stijn Blot
Abstract
Why, in the first quarter of the twenty-first century, do pressure injuries (PIs) remain a perennial problem for patients admitted in the intensive care unit (ICU)? PIs are associated with substantial morbidity, thereby burdening the patient and the healthcare system through pain, emotional distress, recovery, and prolonged hospitalization ICU patients have one of the highest incidence and prevalence rates of PI as they often combine a high index of acute illness with underlying conditions (e.g., chronic obstructive pulmonary disease) facilitating skin breakdown ICU patients have a nearly fourfold higher risk for hospital-acquired PI compared to non-ICU patients International data from 1117 ICUs in 90 countries highlighted an ICU-acquired PI prevalence of 16.2% (95% confidence interval [CI], 15.6-16.8) Compared with countries with a high-income economy, the prevalence of ICU-acquired PIs appears higher in low-and lower-middle-income economies (odds ratio 1.8, 95% CI 1-3.3) Nearly one-third of all PI occur on the sacrum and heels Device-related PIs accounts for up to 74% of all reported ICU-acquired PIs Albeit that generic PI risk scores have demonstrated their value in non-ICU populations, prediction of ICU-acquired PIs remains challenging because of variations in heterogeneity, and the determinative importance of local case-mix, and organizational factors Anyhow, ICU-specific risk factors often include aspects of organ support such as vasopressor use, mechanical ventilation, and renal replacement therapy Therefore, ICU patients represent a unique population where the risk for PIs is arguably different in many ways from other patient groups.