Terapia de fotobiomodulação em lesões por pressão relacionada a dispositivos médicos: relato de caso em lábio de um paciente adulto / Photobiomodulation therapy for medical device-related pressure injuries: a case report of an adult with lip involvement

Lesão por pressão relacionada a dispositivos médicos é uma complicação bastante comum e geralmente oriunda da fixação do dispositivo utilizado na intubação endotraqueal para ventilação mecânica. Desta forma, o presente estudo reportou o caso de um paciente do sexo masculino, 65 anos, leucoderma, internado em uma unidade de terapia intensiva, e que desenvolveu lesão ulcerada na região de fixação do dispositivo utilizado para intubação orotraqueal. Após alívio da pressão local exercida, terapia de fotobiomodulação foi proposta como única estratégia para cicatrização da lesão e diminuição do edema. Após 3 sessões diárias foi possível observar excelente curso de reparação tecidual e remissão dos sinais flogísticos. De acordo com o presente caso, a terapia de fotobiomodulação parece ser bastante eficiente para o tratamento de lesões por pressão relacionada a dispositivos médicos(AU)

Medical device-related pressure injuries are very common complications and usually arise from the fixation of the device used in endotracheal intubation for mechanical ventilation. Thus, the present study reports a case of a Caucasian male patient, 65 years old, who was admitted to an intensive care unit and developed later an ulcerated lesion on the region of fixation of the device used for orotracheal intubation. After relieving the local pressure exerted, photobiomodulation therapy was proposed as the only strategy for wound healing and edema reduction. After 3 daily sessions, it was possible to note an excellent tissue repair course and remission of phlogistic signs. According to the present case, photobiomodulation therapy appears to be a quite efficient treatment strategy for medical device-related pressure injuries(AU)

Lesiones por presión: la incidencia en el paciente crítico con neumonía por SARS-CoV-2, en respuesta a la estrategia del decúbito prono durante la pandemia COVID-19 / Pressure lesions: incidence in critical patient with pneumonia due to SARS-CoV-2, in response to decubitus prone position during COVID-19 pandemic

Introducción: Se suele aplicar en pacientes con SARS-CoV-2 el decúbito prono (DP) prolongadamente, pues ha demostrado beneficios para solventar la falta de equipos de ventilación mecánica; sin embargo, también tiende a producir lesiones por presión (LPP) en regiones anatómicas no experimentadas en otras prácticas. Objetivo: Calcular la incidencia de LPP en el paciente crítico de COVID-19 en DP, describir características de los pacientes y las lesiones. Metodología: Estudio observacional, descriptivo, de carácter transversal con enfoque retrospectivo. La recolección de datos se realizó en un hospital de tercer nivel de la Ciudad de México, incluyó 230 pacientes que desarrollaron LPP posterior a su ingreso. Se analizó el expediente electrónico y los registros de la clínica de heridas, la recolección de datos se generó en Excel y el análisis estadístico en el programa SPSS. Resultados: La incidencia fue de 18.05%, las LPP con esfacelo corresponden al 33.9% y las de necrosis al 40%. La localización anatómica en pabellón auricular, pómulos y tórax fue de 36.1% y 46.5% fueron lesiones de categoría III con afectación de las estructuras musculares. La correlación con el IMC demostró que pacientes con sobrepeso presentaron mayor incidencia de LPP con fibrina y esfacelo en un 60.3%. Limitación del estudio: No se consideraron variables como la carga de trabajo de enfermería. Originalidad: Esta investigación no ha sido postulada previamente en ningún órgano editorial. Conclusiones: La incidencia coincide con estudios en otros países, por lo que es necesario estandarizar las acciones para la prevención de LPP y reducir su incidencia.

Introduction: Prolonged prone decubitus (PD) is usually applied in patients with SARS­CoV­2, as it has shown benefits to solve the lack of mechanical ventilation equipment; however, it also tends to produce pressure injuries (PI) in anatomical regions not experienced in other practices. Objective: To calculate the incidence of PI in the critical patient of COVID-19 in PD, describe patient characteristics and injuries. Methodology: Observational, descriptive, cross-sectional study with retrospective approach. Data collection was performed in a tertiary level hospital in Mexico City, including 230 patients who developed PI after admission. The electronic file and wound clinic records were analyzed, data collection was generated in Excel and statistical analysis in the SPSSs program. Results: The incidence was 18.05%, PI with slough corresponded to 33.9% and those with necrosis to 40%. The anatomical location in the pinna, cheekbones and thorax was 36.1% and 46.5% were category III lesions with involvement of muscular structures. Correlation with BMI showed that overweight patients had a higher incidence of PI with fibrin and sphacel in 60.3%. Limitation of the study: variables such as nursing workload were not considered. Originality: This research has not been previously postulated in any editorial body. Conclusions: The incidence coincides with studies in other countries, so it is necessary to standardize actions for the prevention of PI and reduce its incidence.

Covid-19: um resgate bibliográfico sobre práticas exitosas na prevenção de lesões por pressão / COVID-19: A Bibliography Review on Successful Practices in Pressure Injuries Prevention / COVID-19: Un Rescate Bibliográfico sobre PrácticasExitosas en la Prevención de Lesiones por Presión

Introdução:Em dezembro de 2019 na China, o SARS-CoV-2 foi identificado e declaradocomopandemiapelaOrganização Mundial da Saúde.Suatransmissibilidade entrehumanos e evoluçãocomestabilidade clínicaehemodinâmica, aumentam o risco dodesenvolvimento delesões por pressãonos pacientes mais críticos.Objetivo:Identificar os principais cuidados hospitalares para manter a integridade da pele nos pacientes com COVID-19propensos a lesão por pressão. Metodologia:Estudo descritivo do tipo revisão integrativa realizado nas bases: Literatura Latino-Americana de Ciências da Saúde, Base de Dados de Enfermagem,Scientific Eletronic Library OnlineeBiblioteca Nacional de Medicina dos Estados Unidoscom osdescritores COVID-19, Lesão por pressão, Assistência ao pacienteePadrões de referência. Os critérios de inclusãoforamtextos completosdisponíveis gratuitamente, publicados entre 2019 e2021, que compartilhassem da temáticaem adultos e/ou idosos.Foramexcluídos artigos incompletos,plataformas pagas, cartae notas editor, reflexões e os artigos duplicados foram contabilizados uma vez, o idioma de origem não foi fator excludente.Resultados:Foram identificados 398 artigos potencialmente relevantes e 7 foram selecionados. As principais práticas relacionadas a prevenção de lesões por pressão em pacientes com COVID-19 apontamintervenções como o uso de checklist, avaliação periódica da pele,definiçãodo risco de desenvolvimento de lesão por pressão, mudança de decúbito conforme tolerância do paciente, uso de superfície para redistribuição de peso, cobertura profilática multicamadase controle da umidade da pele. Conclusões:As principais práticasparaevitar aslesões por pressãonos pacientes com COVID-19 no ambiente hospitalarestãoassociadas como cuidado direto ou indiretamente ligados a pele,adoção de medidas preventivas e sistemáticas dentro da realidade clínica e hemodinâmica dos pacientes (AU).

Introduction:In December 2019, in China, SARS-CoV-2 virus was identified and a pandemic was declared by the World Health Organization. Its transmissibility among humans and evolution with clinical and hemodynamic stability increases the risk of developingpressure injuries in the most critical patients.Objective:To identify the main hospital care to maintain skin integrity in COVID-19patients prone to pressure injuries.Methodology:A descriptive study of integrative review carried out in the following bases: Latin-American Health Sciences Literature, Nursing Database, Scientific Electronic Library Online and the National Library of Medicine of the United States, with the descriptors COVID-19, Pressure Injuries, Patient Care and Benchmarks. Inclusion criteria were full texts available for free, published between 2019 and 2021, which shared the subject matter in adults and/or elderly people. Incomplete articles, paid platforms, editor'sletter and notes, and reflections were excluded; duplicate articles were counted once. The source language was not an excluding factor.Results:398 potentially relevant articles were identified, 7 were selected. The main practices related to the prevention of pressure injuries in patients with COVID-19 point to interventions such as the use of checklists, periodic skin assessment, definition of the risk of developing pressure injuries, change of decubitus according to the patient's tolerance, use of surface for weight redistribution, multi-layer prophylactic coverage and skin moisture management.Conclusions:The main practices to avoid pressure injuries in patients with COVID-19in the hospital environment are associated with care directly or indirectly linked to the skin, adoption of preventive and systematic measures within the clinical and hemodynamic reality of patients (AU).

Introducción: Endiciembre de 2019, en China, el SARS-CoV-2 fue identificado y declarado pandemia por laOrganización Mundial de la Salud. Su transmisibilidad entre humanos y la evolución conestabilidad clínica yhemodinámica aumentan el riesgo de desarrollar lesiones por presión en lospacientes más críticos. Objetivo:Identificar los principales cuidados hospitalarios para mantener la integridad de la piel en pacientes con COVID-19propensos a lesiones por presión. Metodología:Estudio descriptivo del tipo "revisiónintegradora" realizado em las bases de datos: Literatura Latinoamericana de Ciencias de la Salud, Base de Datos de Enfermería, ScientificEletronic Library Online (Biblioteca Electrónica Científica en Línea) y Biblioteca Nacional de Medicina de los EstadosUnidos con los identificadores COVID-19, Lesión por Presión, Atención al Paciente y Estándares de Referencia. Loscriterios de inclusión fueron textos completos disponiblesde forma gratuita, publicados entre el 2019 y 2021, quecompartieron el tema en adultos y/o ancianos.Se excluyeronlos artículos incompletos, las plataformas pagadas,las cartas y las notas del editor y las reflexiones. Los artículos duplicados se contaron una vez. El idioma de origenno fue un factor de exclusión. Resultados:Se identificaron un total de 398 artículos potencialmente relevantes, 7fueron seleccionados. Las principales prácticasrelacionadas con la prevención de lesiones por presión em pacientes con COVID-19 apuntan a intervenciones como el uso de checklist, evaluación periódica de la piel,riesgo de lesión por presión, cambio de decúbito según tolerancia del paciente, uso desuperficie para redistribución de peso, cobertura profiláctica multicapa y control de la humedad de la piel.Conclusiones:Lasprincipales prácticas para evitar lesiones por presión en pacientes con COVID-19 en el ámbitohospitalario se asocian con cuidados directa o indirectamente vinculados a la piel, adopción de medidaspreventivas y sistemáticas dentro de la realidad clínica y hemodinámica de los pacientes (AU).

Braden scale has low reliability in different patients under care in intensive care unit

SUMMARY OBJECTIVE: The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS: This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS: For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS: Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.

Bedsore is a curse in disguise: capturing the zeitgeist

Background: Development of a bedsore is always avoidable still its worldwide prevalence fluctuates between 0%-56%. Bedsores are maximally observed in patients who are on long term care, in intensive care, immuno-compromised or on home care.Methods: In a tertiary care center-JK hospital, Bhopal, a longitudinal observational study was done for a duration of 3 years, on all registered in-patients, to understand the trend of bedsore rates on monthly basis.Results: In our study, even though, on yearly basis, average of rates is showing a declining trend in favorable manner yet higher statistical analysis (ANOVA test p value = 0.054) has decrypted the non-significant results.Conclusions: Timely and appropriate prophylactic interventions are needed to overcome the increased bedsore rates. Checklist based surveillance and monitoring should be a pressing priority. Cochrane reviews are also suggestive of incorporation of organizational changes, risk assessment tools, wound care teams and education to reduce the incidence of pressure ulcers.

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment / 中华烧伤杂志

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Recommendations for prevention and treatment of device-related pressure injuries during COVID-19 period / 药学实践杂志

With the outbreak of COVID-19, non-stop working medical staff need to wear protective equipment for a long time, which could easily cause device-related pressure injuries to nose, cheek, forehead or the back of auricle, and might even cause facial skin swelling and ulceration. The above problems reduce work efficiency and increase the infection risk for healthcare people. This article introduces the concept of device-related pressure injuries and summarizes the progress of the treatment for device-related pressure injuries at home and abroad in recent years, aiming at providing guidance for frontline medical staff to prevent device-related pressure injuries.

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment / 中华烧伤杂志

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Community versus Hospital Acquired Pressure Injuries: An Assessment of Predisposing Risk Factors

@#Introduction: Pressure injuries are a common problem in acute and chronic healthcare settings with critical morbidity and mortality consequences on patients and healthcare systems. The objective of this study was to assess the predisposing risk factors associated with patients with community acquired pressure injuries and hospital acquired pressure injuries. Methods: Data were drawn from patients' electronic medical records from two hospitals with a total of 784 beds in the North Texas area and 94 records of HAPI and 206 records of CAPI patients were assessed. The measures examined included patients' socio-demographic variables, admission diagnosis, and Braden scale measures. Results: Scores for Albumin, weight, body mass index, length of stay and Braden measures were significantly higher for HAPI than CAPI patients at α < 0.05. Higher total Braden scores (OR=1.25, 95%CI: 1.15, 1.41), friction (OR=2.44, 95%CI: 1.39, 4.27), and longer length of stay (OR=1.13, 95%CI: 1.09, 1.18) were associated with a higher likelihood of HAPI. Conclusions: Interventions aimed at prevention of pressure injuries should target reducing friction and length of stay at care facilities.

The effect of cluster skin management on children with critical congenital heart disease / 中国实用护理杂志

Objective@#To explore the effect of cluster skin management (SSKIN) on reducing the incidence of stress skin injury in children with congenital heart disease during perioperative period.@*Methods@#Delphi method was used to establish cluster skin management specialty to formulate SSKIN. Skin outcomes of 863 children before SSKIN implementation (control group) and 819 children after SSKIN implementation (experimental group) were analyzed and compared through personnel training, program application and supervision.@*Results@#The incidence of stress skin injury, stage I stress skin injury and occipital pressure injury were 5.1% (44/863), 4.4% (38/863), 2.5% (22/863) in the control group and 2.3% (19/819), 2.2% (18/819), 0.7% (6/819) in the experimental group, respectively. There were significant differences between the two groups (χ2 = 8.999, 6.350, 8.472, P < 0.01 or 0.05). The incidence of stress skin injury in delayed chest closure and continuous positive airway pressure were 27.9%(17/61), 23.4%(18/77) in the control group and 11.5%(6/52), 8.9%(7/79) in the experimental group, respectively. There were significant differences between the two groups(χ2=4.618, 6.105, P<0.05).@*Conclusions@#The SSKIN is effective at prevent congenital heart disease patients with high risk of stress skin injury. It can improve the skin outcomes in children.

The effect of cLuster skin management on chiLdren with criticaL congenitaL heart disease / 中国实用护理杂志

Objective To explore the effect of cluster skin management (SSKIN) on reducing the incidence of stress skin injury in children with congenital heart disease during perioperative period. Methods Delphi method was used to establish cluster skin management specialty to formulate SSKIN. Skin outcomes of 863 children before SSKIN implementation (control group) and 819 children after SSKIN implementation (experimental group) were analyzed and compared through personnel training, program application and supervision. ResuLts The incidence of stress skin injury, stage I stress skin injury and occipital pressure injury were 5.1% (44/863), 4.4% (38/863), 2.5% (22/863) in the control group and 2.3% (19/819), 2.2% (18/819), 0.7% (6/819) in the experimental group, respectively. There were significant differences between the two groups (χ2=8.999, 6.350, 8.472, P<0.01 or 0.05). The incidence of stress skin injury in delayed chest closure and continuous positive airway pressure were 27.9%(17/61), 23.4%(18/77) in the control group and 11.5%(6/52), 8.9% (7/79) in the experimental group, respectively. There were significant differences between the two groups(χ2=4.618, 6.105, P＜0.05). ConcLusions The SSKIN is effective at prevent congenital heart disease patients with high risk of stress skin injury. It can improve the skin outcomes in children.