Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

[Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19]. / Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

[Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19]. / Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

Pressure Ulcers in COVID-19 Patients in the Intensive Care Unit

Objective: Pressure ulcer (PU) in Coronavirus disease-2019 (COVID-19) patients will be an important health and cost factor for all countries. Risk factors for the development of PU in patients admitted to intensive care unit (ICU) during the COVID-19 pandemic were evaluated in terms of treatment and outcomes. Methods: Patients were divided into two groups (group I= developing PU, group II= did not develop PU). Results: A total of 105 patients were included in the study. PU developed in 20 patients (19%). The mean age was 58.45±13.35, days of PU development was 6. The duration of uninterrupted prone positioning was 23.55±4.38 hours among the study patients. The duration of ICU stay and mechanical ventilation duration of group I cases were longer than the durations of group II cases. There was no significant difference between the groups in terms of gender percentages, age, albumin, hemoglobin and C-reactive protein values (p>0.05). Conclusion: Prolonged prone position are independent risk factors for the development of PU in COVID-19 patients. [ABSTRACT FROM AUTHOR] Copyright of European Archives of Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Society of Critical Care Medicine 52nd Critical Care Congress

472 HOSPITAL-ACQUIRED ACHROMOBACTER DENITRIFICANS BACTEREMIA: CASE REPORT AND REVIEW OF LITERATURE 473 MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (MIS-A) AFTER COVID-19 INFECTION 474 RISK FACTORS FOR EARLY-ONSET MDRO INFECTIONS IN CRITICALLY ILL PATIENTS 475 DESCENDING NECROTIZING MEDIASTINITIS FROM PERITONSILLAR ABSCESS PRESENTING AS A STEMI 476 OUTCOMES OF PATIENTS AGED 85 YEARS OR OLDER ADMITTED WITH COVID-19 477 BABESIOSIS AND RED BLOOD CELL EXCHANGE TRANSFUSION: CONSIDER IT EARLY 478 REFRACTORY TOXIC SHOCK SYNDROME: IV IMMUNOGLOBULIN TO THE RESCUE! 390 IMPACT OF VACCINATION ON COST AND COURSE OF HOSPITALIZATION ASSOCIATED WITH COVID-19 INFECTION Research Snapshot Theater: Infection III PUBLISHING NUMBER 391 THE PROGNOSTIC VALUE OF ICHIKADO SCORES AND CCI FOR HOSPITALIZED PATIENTS WITH COVID-19 PNEUMONIA 392 PROGNOSTIC MARKERS OF GERIATRIC PATIENTS IN THE ICU WITH RESPIRATORY FAILURE SECONDARY TO COVID-19 393 SEVERE SUPPURATIVE SIALADENITIS IN A COVID-19-POSITIVE PATIENT 394 A CASE OF EXTENSIVE NECROTIZING FASCIITIS DUE TO STRING TEST-NEGATIVE KLEBSIELLA PNEUMONIAE 395 IMPACT OF BMI ON MORTALITY, MECHANICAL VENTILATION, AND LENGTH OF STAY IN COVID-19 PATIENTS 396 IMPACT OF OBESITY ON CLINICAL OUTCOMES IN PATIENTS RECEIVING ACYCLOVIR FOR HSV ENCEPHALITIS 397 DEGREE OF THROMBOCYTOPENIA IN HOSPITALIZED COVID-19 PATIENTS WITH EBV AND CMV COINFECTION 398 ICU MANAGEMENT OF SEVERE BABESIOSIS IN AN IMMUNOCOMPROMISED ASPLENIC PATIENT Research Snapshot Theater: Infection IV PUBLISHING NUMBER 399 A CASE OF SEVERE BABESIOSIS REQUIRING EXCHANGE TRANSFUSION 400 BLOOD RNA BIOMARKERS DISTINGUISH IMMUNE RESPONSES TO COVID-19 VIREMIA VERSUS COMORBID INFECTIONS 401 HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A HIDDEN SURPRISE UNDER THE GARB OF DENGUE FEVER?. [Extracted from the article]

Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study.

BACKGROUND: Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM: This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN: This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS: In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION: The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE: The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.

Neurocognitive and Psychological Profile of a 57-Year-Old Long-COVID Patient After 42 Days an a Ventilator

Objective: The neuropsychological impact of COVID-19 is a budding area of research. Studies suggest greater neurological abnormalities in patients presenting with a severe illness course, particularly those with acute respiratory distress syndrome. The purpose of this case study was to characterize the neurocognitive and psychological profile of a 57-year-old male following prolonged hospitalization for COVID-19 in March 2020, including 42 days on mechanical ventilation. Method: Relevant data were collected via clinical interview, neuropsychological testing, and medical record review. Hospital course was notable for hypertension, acute kidney failure, and pressure ulcers. Computerized tomography and electroencephalogram revealed mild cortical atrophy and mild to moderate generalized slowing, respectively. Approximately 15 months post-discharge, subjective complaints during the evaluation included cognitive "fogginess," increased impulsivity, decreased frustration tolerance, forgetfulness, fatigue, mobility difficulties, and dyspnea upon exertion. Results: Neuropsychological testing, within the context of likely average premorbid functioning, revealed declines in motor functioning, confrontation naming, phonemic fluency, planning/organization, visual memory, and aspects of verbal memory. Poor performance on select memory tasks was likely driven by executive dysfunction. Behaviorally, the patient presented as disinhibited, impulsive and labile. Emotionally, he endorsed symptoms of posttraumatic stress, anxiety, and depression. These post-COVID-19 sequelae have impacted functioning across multiple domains including ability to work, medication and finance management, and complex decision-making. Conclusions: Results suggest bilateral frontal and temporal dysfunction rather than subcortical deficits from hypoxia. Similar to post-intensive care syndrome, the etiology of functional impairment in severely ill, hospitalized COVID-19 patients appears multifactorial. Likely mediating factors include COVID-19 itself, associated complications, intervention methods, and psychological distress. [ FROM AUTHOR] Copyright of Archives of Clinical Neuropsychology is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Folgeschäden durch Beatmung in Bauchlage bei COVID-19 und ihre Relevanz für die Frührehabilitation – eine retrospektive Kohortenstudie

Background Prone positioning is a therapy option for patients with Acute Respiratory Distress Syndrome. It has become more relevant and common during the COVID-19 pandemic. Among known side effects, pressure ulcers (PU) and peripheral nerve lesions (PNL) are the most relevant Methods In this retrospective cohort study we investigated the prevalence of PU and PNLin COVID-19 patients, who had been treated with prone positioning and had later been referred to an acute rehabilitation unit. Potential determinants for the occurrence of PU and PNL were identified. Potential effects of PU and PNL on the functional outcome of patients after acute rehabilitation were assessed. Results 52 patients were included in this study. 78.8% had typical ventral PU at the time of referral to the acute rehabilitation unit, 10% showed clinical features of PNL. Patients with PNL had diabetes as a preexisting condition more frequently than patients without. The occurrence of PU could not be correlated with any risk factor. On admission to acute rehabilitation patients with PNL were less mobile and less selfsufficent than patients without PNL, however on discharge there were no more differences in mobility and self-sufficency. Patients with PNL needed significantly more aids. PU are very common, mainly affecting the face and neck (56,1%). Conclusion This study shows that complications of BL are common on admission to acute rehabilitation. While mobility is lower on admission of patients with PNL, no such difference can be seen on discharge. Overall, patients with proning sequae don't seem to be impaired in their mobility and ADL performance beyond their time in acute rehabilitation.

Cold Plasmamed Beam as a Supporting Treatment of Soft Tissue Injuries in Severe Covid-19 Patients: A Preliminary Report.

Background: Cold plasma has many characteristics that allow for effective wound healing. Due to its efficacy, we have applied it in treating patients with severe Covid-19 who have soft tissue skin lesions and diseases including burns, pressure ulcers, shingles, and contact or atopic dermatitis. This study aims to assess the general characteristics of Covid-19 patients with soft tissue lesions and to conduct a fundamental evaluation of the efficacy of cold plasmamed beams in treating soft tissue wounds in patients with severe Covid-19. Methods: This prospective study was conducted on 20 severe Covid-19 patients with soft tissue lesions at the Intensive Care Center for Covid-19 of Hue Central Hospital in Ho Chi Minh City from September 25 to November 11, 2021. These patients was performed cold plasma irradiation at any stage of wound progression, including new injuries and chronic wounds. Results: Among 915 severe Covid-19 patients treated at our center, 20 patients had soft tissue lesions. Grade I, II, and III pressure ulcers accounted for 70% of the 20 cases of soft tissue lesions and 1.53% of the total patients at the time of the survey. Pressure ulcers were present in only 0.55% of patients (5/915 patients). Eleven out of 20 patients (55.0%) had lesions before admission, and 9 (45.0%) had lesions that appeared after admission. After 14 days of treatment, 14/20 patients had complete epithelialization (70%), and in 18/20 patients, wound exudation had ceased. The wounds became painless; after 3 weeks, the rashes had completely disappeared. Conclusion: The study emphasizes that irradiation with cold plasma contributes to the wound healing process.

A computational framework to support the treatment of bedsores during COVID-19 diffusion.

The treatment of pressure ulcers, also known as bedsores, is a complex process that requires to employ specialized field workforce assisting patients in their houses. In the period of COVID-19 or during any other non-trivial emergency, reaching the patients in their own house is impossible. Therefore, as well as in the other sectors, the adoption of digital technologies is invoked to solve, or at least mitigate, the problem. In particular, during the COVID-19, the social distances should be maintained in order to decrease the risk of contagion. The Project Health Management Systems proposes a complete framework, based on Deep Learning, Augmented Reality. Pattern Matching, Image Segmentation and Edge Detection approaches, to support the treatment of bedsores without increasing the risk of contagion, i.e., improving the remote aiding of specialized operators and physicians and involving inexperienced familiars in the process.

Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

The aim of the study was to explore the effects of Intentional Rounding, a regular-based proactive patient monitoring, on falls and pressure ulcers in internal medicine units. This is a cluster-randomised controlled study, where units were assigned (1:1) to Intentional Rounding (intervention group) or Standard of Care (control group). The primary outcome was the cumulative incidence of falls and new pressure ulcers. These events were considered separately as secondary endpoints, together with the number of bell calls and the evaluation of patient satisfaction. Primary analyses were carried out on the modified intention-to-treat population (hospitalisation of at least 10 days). Recruitment occurred between October 2019 and March 2020, at which time the study was prematurely closed due to the COVID-19 pandemic. Enrolment totalled 1822 patients at 26 sites; 779 patients were included in the modified intention-to-treat analysis. The intervention group had a lower risk of falls (adjusted incidence rate ratio 0.14; 95% confidence interval, 0.02-0.78; p = 0.03). There were no statistical differences in new pressure ulcers or the cumulative incidence of both adverse events. Mean bell calls for each patient were 15.4 ± 24.1 in the intervention group and 13.7 ± 20.5 in the control group (p = 0.38). Additionally, patient satisfaction in the intervention group was almost at the maximum level. Our study supports the usefulness of Intentional Rounding in a complex and vulnerable population such as that hospitalised in internal medicine units.

Development of novel customized pressure distribution surface for reduction of pressure ulcers using additive manufacturing technology

Purpose>This research aims to focus on developing a customized support surface using additive manufacturing (AM) for effective pressure relief for patients who are in bed or wheelchair suffering from pressure ulcers (PU).Design/methodology/approach>A novel customized support surface is developed using AM technology incorporated with magnetic levitation and ball and socket mechanisms. Magnetic levitation provides cushioning effect for the developed cushion to users who are sitting in a wheelchair and increases the rate of healing. The ball and socket mechanism provides the user body's self-adaptive mechanism and reduces shear and friction forces between the surfaces of the additive manufactured cushion and the human buttocks.Findings>From the results of ISO 16480-6 biomechanical standardized tests, the additive manufactured support surface performed better than, or on par with, the most widely available commercial cushions. It is evident that the developed cushion’s peak pressure values are lower when compared with other cushions. The overall efficiency of the developed cushion was qualitatively reported;67% of people felt it was excellent and 22% of people responded as good and 11% were satisfactory. Henceforth, the overall effectiveness of the developed support surface provides a better experience to the end-user in the view of PU reduction.Originality/value>A developed additive manufactured customized support surface will be an alternative approach for the reduction of PU, and it overcomes the drawbacks faced by the currently available cushions.

Pressure ulcers from prone positioning in COVID-19 patients: Developing clinical indicators in evidence-based practice: A retrospective study

Background: A notable pandemic arisen during the COVID-19 pandemic has developed globally in intensive care units, with patients developing pressure ulcers (PUs) after being ventilated mechanically in the prone position. Objectives: The aim was to identify risk factors independently predictive of the development of PUs in adult patient populations treated with prone positioning and to evaluate a possible epidemiological association between the prevalence of PUs and specific clinical characteristics so as to develop clinical indicators for the prevention of PUs. Finally, the aim was to examine our study participants against the incidence of PUs with respect to the length of their stay. Methods: This retrospective study enrolled patients hospitalized during the period of May 2020 through January 2021. Data was collected from 299 patients hospitalized and having required prone positioning ventilatory therapy in critical care areas (short-stay units, emergency units, and intensive care units), all of which had developed Pus of at least grade two according to the classification system proposed by the NPUAP/EPUAP. Results: Patients who had developed PUs had a longer hospitalization stay overall and were more prone to die during hospitalization. Patients who developed Pus were more frequently males, with higher initial levels of CPK and ferritin.Conclusions: The study reveals valuable information on the most important risk factors in the development of PUs due to prone positioning. We have described how the total number of days of hospitalization is significantly related to the development of PUs. Even a PU is not a life-threatening lesion, the implementation of improved positioning protocols may enhance results in critical patient care. We believe that this is a current, globally underestimated problem as the incidence of COVID-19 patients requiring prone positioning—and, therefore, at risk for PUs—is increasing daily. [ FROM AUTHOR] Copyright of Our Dermatology Online / Nasza Dermatologia Online is the property of Our Dermatology Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study.

The pandemic of coronavirus (COVID-19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID-19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty-five COVID-19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty-three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy-six (55.87%) patients underwent non-invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First-degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first-degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID-19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.

Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence.

OBJECTIVE: Many patients with COVID-19 admitted to intensive care undergo prone positioning. These patients are at risk of developing facial pressure ulcers (PUs). This study aimed to identify evidence-based recommendations to prevent or reduce their incidence. METHOD: A multi-case study was undertaken using secondary data published between November 2020 and April 2021 discussing facial PUs in patients with COVID-19. CINAHL and MEDLINE electronic databases were analysed. Sixteen publications met the inclusion criteria. The overall quality of evidence was low. RESULT: Studies reported a high incidence of facial PUs. The evidence suggests key preventive areas are skin assessment, pressure-redistribution surfaces, eye coverings, education, medical devices and prophylactic dressings. Recommendations included skin cleaning and moisturising, eye coverings, replacing endotracheal tube holders and using hydrocolloid or film dressings. CONCLUSION: Considering the severe implications for patients and healthcare systems caused by facial PUs, ICUs should develop strategies to prevent and minimise them.

The diversity and outcome of post-covid mucormycosis: A case report.

INTRODUCTION AND IMPORTANCE: The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival. CASE PRESENTATION: The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap. CLINICAL DISCUSSION: The dual effect of both covid-19 and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is recommended. CONCLUSION: Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology.

The aetiology of medical device-related pressure ulcers and how to prevent them.

This article provides an introduction to the aetiology of medical device-related pressure ulcers (MDRPUs), describes the vicious cycle that leads to these injuries and highlights bioengineering methodologies and findings that connect the aetiology to the clinical practice of preventing MDRPUs. Specifically, the vicious cycle of MDRPUs is triggered by the sustained tissue deformations induced by a skin-contacting device. The primary, deformation-inflicted cell damage leads to a secondary inflammatory-oedema-related damage and then to tertiary ischaemic damage. Each of these three factors contributes to cumulative cell death and tissue damage under and near the applied device. The damage therefore develops in an escalated manner, as a result of the added contributions of the above three factors. This phenomenon is exemplified through two common clinical scenarios. First, through the use of continuous positive airway pressure (CPAP) masks, which are being applied extensively in the current COVID-19 pandemic, and, second, through the use of doughnut-shaped head positioners, which are applied to surgical patients and sometimes to bedridden individuals who receive intensive care in a supine position. These two medical devices cause intense, localised mechanical loads in the facial skin and underlying tissues (CPAP mask) and at the occipital scalp (doughnut-shaped positioner), where the soft tissues cannot swell in response to the inflammatory oedema as, in both cases, the tissues are sandwiched between the device and the skull. Accordingly, the two device types result in characteristic MDRPUs that are avoidable through appropriate prophylactic interventions, that is, preventive dressings under the CPAP mask and replacement of the doughnut device by a soft, shape-conforming support aid to alleviate and disperse the localised soft tissue deformations. Hence, understanding the aetiology of MDRPUs targets and focuses effective clinical interventions.

Complications of prone positioning in patients with COVID-19: A cross-sectional study.

OBJECTIVE: To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. METHODS: Cross-sectional study conducted in the hub COVID-19 centre in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS: A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if no unplanned extubation was recorded. The majority of patients (17.5%) experienced bleeding of upper airways. Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04-3.6). CONCLUSION: The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.

Prevención de lesiones cutáneas causadas por productos y equipos de protección personal durante COVID-19: revisión de alcance.

OBJECTIVE: Identify, summarise and present key recommendations published in the literature to prevent skin damage in health professionals as a result of personal protective equipment (PPE) during the covid-19 pandemic. METHOD: A scoping review, based on the Joanna Briggs Institute guidelines, was carried out between December 2019 and May 2020. The studies included male and female health professionals, who wore PPE during the global pandemic, in any given scenario. Headings and abstracts were analysed. Two independent investigators reviewed the full text. RESULTS: Eight publications were included. All of them focused on preventing pressure ulcers (PU) caused by PPE. Hygiene, hydration and the use of skin barriers were highlighted as preventive measures. There were different views around the type of humectant/skin barrier recommended to avoid skin damage. CONCLUSION: More studies identifying the most suitable strategies to maintain health professionals' skin integrity during the covid-19 pandemic are needed.

OBJETIVO: Identificar, resumir y presentar las recomendaciones publicadas para prevenir lesiones cutáneas (cualquier alteración de la piel) por el uso de productos y equipos de protección personal (EPP) en profesionales de la salud durante la pandemia del COVID-19. MÉTODO: Se realizó una revisión de alcance, basada en las sugerencias del Instituto Joanna Briggs, entre diciembre de 2019 y mayo de 2020. Se incluyeron estudios realizados con profesionales de la salud de ambos sexos, que utilizaron productos y EPP durante la pandemia, en cualquier escenario de la atención sanitaria. Se examinaron los títulos y resúmenes de los estudios. Dos revisores independientes evaluaron el texto completo, según los criterios de inclusión establecidos. RESULTADOS: Ocho publicaciones fueron seleccionadas. Todas se centraron en los cuidados relacionados con la prevención de lesiones por presión (LPP). Resaltaron la higiene e hidratación, y el uso de protectores cutáneos como medidas preventivas. CONCLUSIÓN: Es necesario llevar a cabo investigaciones en busca de mejores estrategias para mantener la integridad de la piel de los profesionales de la salud en el ejercicio de su profesión durante el COVID-19. CONFLICTO DE INTERÉS: Este artículo es parte de un proyecto apoyado por el Ministerio de Ciencia, Tecnología e Innovaciones (MCTI) y el Consejo Nacional de Desarrollo Científico y Tecnológico (CNPq) de Brasil.

Benefits of sucrose octasulfate (TLC-NOSF) dressings in the treatment of chronic wounds: a systematic review.

OBJECTIVE: Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers. METHOD: A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings. RESULTS: A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition. CONCLUSION: All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.