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1.
AACN Adv Crit Care ; 33(2): 173-185, 2022 Jun 15.
Article in English | MEDLINE | ID: covidwho-1879533

ABSTRACT

BACKGROUND: Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS: Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS: A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS: Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.


Subject(s)
COVID-19 , Pressure Ulcer , Humans , Intensive Care Units , Predictive Value of Tests , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Risk Assessment , Risk Factors
2.
J Tissue Viability ; 31(2): 213-220, 2022 May.
Article in English | MEDLINE | ID: covidwho-1851676

ABSTRACT

AIM: This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries. METHOD: Relevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15-25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained. RESULTS: 17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%-82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8-88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region. CONCLUSION: PPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.


Subject(s)
COVID-19 , Pressure Ulcer , COVID-19/epidemiology , COVID-19/prevention & control , Health Personnel , Humans , Pandemics/prevention & control , Personal Protective Equipment/adverse effects , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Pruritus , Retrospective Studies
3.
Cells ; 11(8)2022 04 09.
Article in English | MEDLINE | ID: covidwho-1785540

ABSTRACT

The risk of complications following surgical procedures is significantly increased in patients with SARS-CoV-2 infection. However, the mechanisms underlying these correlations are not fully known. Spinal cord injury (SCI) patients who underwent reconstructive surgery for pressure ulcers (PUs) before and during the COVID-19 pandemic were included in this study. The patient's postoperative progression was registered, and the subcutaneous white adipose tissue (s-WAT) surrounding the ulcers was analyzed by proteomic and immunohistochemical assays to identify the molecular/cellular signatures of impaired recovery. Patients with SCI and a COVID-19-positive diagnosis showed worse recovery and severe postoperative complications, requiring reintervention. Several proteins were upregulated in the adipose tissue of these patients. Among them, CKMT2 and CKM stood out, and CKM increased for up to 60 days after the COVID-19 diagnosis. Moreover, CKMT2 and CKM were largely found in MGCs within the s-WAT of COVID patients. Some of these proteins presented post-translational modifications and were targeted by autoantibodies in the serum of COVID patients. Overall, our results indicate that CKMT2, CKM, and the presence of MGCs in the adipose tissue surrounding PUs in post-COVID patients could be predictive biomarkers of postsurgical complications. These results suggest that the inflammatory response in adipose tissue may underlie the defective repair seen after surgery.


Subject(s)
COVID-19 , Pressure Ulcer , Spinal Cord Injuries , Adipose Tissue/metabolism , COVID-19/complications , COVID-19 Testing , Creatine Kinase/metabolism , Creatine Kinase, Mitochondrial Form/metabolism , Humans , Pandemics , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Pressure Ulcer/surgery , Proteomics , SARS-CoV-2 , Spinal Cord Injuries/complications , Spinal Cord Injuries/surgery , Suppuration/complications , Up-Regulation
4.
J Nurs Manag ; 30(4): 1061-1068, 2022 May.
Article in English | MEDLINE | ID: covidwho-1735960

ABSTRACT

AIM: To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. BACKGROUND: Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. METHOD: This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. RESULTS: A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. CONCLUSIONS: The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. IMPLICATIONS FOR NURSING MANAGEMENT: Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.


Subject(s)
COVID-19 , Pressure Ulcer , Accidental Falls , COVID-19/epidemiology , Humans , Nursing Records , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , 34658
5.
J Nurs Care Qual ; 37(2): 162-167, 2022.
Article in English | MEDLINE | ID: covidwho-1703352

ABSTRACT

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.


Subject(s)
COVID-19 , Pressure Ulcer , COVID-19 Testing , Hospitalization , Hospitals , Humans , Male , Pandemics , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Retrospective Studies , SARS-CoV-2
6.
J Nurs Care Qual ; 37(2): 162-167, 2022.
Article in English | MEDLINE | ID: covidwho-1455413

ABSTRACT

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.


Subject(s)
COVID-19 , Pressure Ulcer , COVID-19 Testing , Hospitalization , Hospitals , Humans , Male , Pandemics , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Retrospective Studies , SARS-CoV-2
7.
Br J Nurs ; 30(15): S24-S30, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1352978

ABSTRACT

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.


Subject(s)
Equipment and Supplies , Pressure Ulcer , COVID-19/epidemiology , Equipment and Supplies/adverse effects , Humans , Pandemics , Pressure Ulcer/etiology , Pressure Ulcer/nursing
9.
Adv Skin Wound Care ; 34(8): 1-3, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1201587

ABSTRACT

ABSTRACT: Prone positioning is recognized for its efficacy in the treatment of acute respiratory distress syndrome related to COVID-19. Here the authors present a case of a facial pressure injury and buried dentition that occurred as a result of prolonged prone positioning in a patient who was COVID-19 positive. The patient was treated with primary closure of the injury and pressure offloading.


Subject(s)
COVID-19/complications , Facial Injuries/surgery , Patient Positioning/adverse effects , Pressure Ulcer/surgery , Prone Position , Aged , COVID-19/therapy , Dentition , Facial Injuries/diagnosis , Facial Injuries/etiology , Humans , Male , Pressure Ulcer/diagnosis , Pressure Ulcer/etiology , Respiration, Artificial/adverse effects
10.
J Trauma Acute Care Surg ; 90(5): 880-890, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1199599

ABSTRACT

BACKGROUND: We sought to describe characteristics, multisystem outcomes, and predictors of mortality of the critically ill COVID-19 patients in the largest hospital in Massachusetts. METHODS: This is a prospective cohort study. All patients admitted to the intensive care unit (ICU) with reverse-transcriptase-polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 14, 2020, and April 28, 2020, were included; hospital and multisystem outcomes were evaluated. Data were collected from electronic records. Acute respiratory distress syndrome (ARDS) was defined as PaO2/FiO2 ratio of ≤300 during admission and bilateral radiographic pulmonary opacities. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality. RESULTS: A total of 235 patients were included. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 5 (3-8), and the median (IQR) PaO2/FiO2 was 208 (146-300) with 86.4% of patients meeting criteria for ARDS. The median (IQR) follow-up was 92 (86-99) days, and the median ICU length of stay was 16 (8-25) days; 62.1% of patients were proned, 49.8% required neuromuscular blockade, and 3.4% required extracorporeal membrane oxygenation. The most common complications were shock (88.9%), acute kidney injury (AKI) (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%). As of July 8, 2020, 175 patients (74.5%) were discharged alive (61.7% to skilled nursing or rehabilitation facility), 58 (24.7%) died in the hospital, and only 2 patients were still hospitalized, but out of the ICU. Age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), higher median Sequential Organ Failure Assessment score at ICU admission (OR, 1.24; 95% CI, 1.06-1.43), elevated creatine kinase of ≥1,000 U/L at hospital admission (OR, 6.64; 95% CI, 1.51-29.17), and severe ARDS (OR, 5.24; 95% CI, 1.18-23.29) independently predicted hospital mortality.Comorbidities, steroids, and hydroxychloroquine treatment did not predict mortality. CONCLUSION: We present here the outcomes of critically ill patients with COVID-19. Age, acuity of disease, and severe ARDS predicted mortality rather than comorbidities. LEVEL OF EVIDENCE: Prognostic, level III.


Subject(s)
COVID-19/complications , COVID-19/mortality , Hospital Mortality , Patient Acuity , Acute Kidney Injury/virology , Adult , Age Factors , Aged , Aged, 80 and over , Antimalarials/therapeutic use , Boston/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Creatine Kinase/blood , Critical Care , Critical Illness , Extracorporeal Membrane Oxygenation , Female , Gastrointestinal Diseases/virology , Humans , Hydroxychloroquine/therapeutic use , Length of Stay , Male , Middle Aged , Neuromuscular Blockade , Organ Dysfunction Scores , Pneumonia, Bacterial/virology , Pressure Ulcer/etiology , Prone Position , Prospective Studies , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/virology , Risk Factors , SARS-CoV-2 , Shock/virology , Steroids/therapeutic use , Survival Rate , Thromboembolism/virology , Treatment Outcome
11.
J Tissue Viability ; 30(3): 283-290, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1193410

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is causing a rapid and tragic health emergency worldwide. Because of the particularity of COVID-19, people are at a high risk of pressure injuries during the prevention and treatment process of COVID-19. OBJECTIVES: This systematic review aimed to summarize the pressure injuries caused by COVID-19 and the corresponding preventive measures and treatments. METHODS: This systematic review was according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Web of science and CNKI (Chinese) were searched for studies on pressure injuries caused by COVID-19 published up to August 4, 2020. The quality of included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale (NOS) and the CARE guidelines. RESULTS: The data were extracted from 16 studies involving 7,696 participants in 7 countries. All studies were published in 2020. There are two main types of pressure injuries caused by the COVID-19: 1) Pressure injuries that caused by protective equipment (masks, goggles and face shield, etc.) in the prevention process; 2) pressure injuries caused by prolonged prone position in the therapy process. CONCLUSIONS: In this systematic review, the included studies showed that wearing protective equipment for a long time and long-term prone positioning with mechanical ventilation will cause pressure injuries in the oppressed area. Foam dressing may need to be prioritized in the prevention of medical device related pressure injuries. The prevention of pressure injuries should be our particular attention in the course of clinical treatment and nursing.


Subject(s)
COVID-19/complications , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Humans , Pandemics , Personal Protective Equipment/adverse effects , Respiration, Artificial/adverse effects , Risk Factors , SARS-CoV-2
12.
Adv Skin Wound Care ; 34(7): 356-363, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1191097

ABSTRACT

OBJECTIVE: To explore the relationship between wearing protective masks and goggles and skin injuries in medical staff during the COVID-19 pandemic. METHODS: Researchers conducted a cross-sectional, multicenter online survey. Respondents voluntarily completed the questionnaire on their smartphones. Ordinal and multinomial logistic regressions were used to identify factors related to skin injuries. RESULTS: In total, 1,611 respondents wore protective masks combined with goggles in 145 hospitals in China; 1,281 skin injuries were reported (overall prevalence, 79.5%). Multiple concomitant skin injuries (68.5%) and injuries in four anatomic locations (24.0%) were the most common, followed by injuries in three (22.8%), two (21.7%), and one location (11.0%). Multinomial logistic regression indicated that sweating increased the risk of injuries in one to four anatomic locations (95% confidence interval for odds ratio 16.23-60.02 for one location and 38.22-239.04 for four locations), and wearing an N95 mask combined with goggles and a daily use longer than 4 hours increased the risk of injuries in four locations (95% confidence interval for odds ratio 1.18-5.31 and 1.14-3.93, respectively). CONCLUSIONS: The prevalence of skin injuries among medical staff wearing protective masks combined with goggles was very high. These were mainly device-related pressure injuries, moisture-associated skin damage, and skin tears. The combination of various factors resulted in skin injuries at multiple sites. Preventing and managing sweating should be a focus for medical staff who wear protective masks combined with goggles for more than 4 hours.


Subject(s)
COVID-19/prevention & control , Eye Protective Devices/adverse effects , Masks/adverse effects , Medical Staff, Hospital/statistics & numerical data , Nursing Staff, Hospital/statistics & numerical data , Occupational Injuries/etiology , Adult , Cross-Sectional Studies , Disease Transmission, Infectious/prevention & control , Facial Injuries/etiology , Humans , Internet , Male , Middle Aged , Personal Protective Equipment/adverse effects , Pressure Ulcer/etiology , Sweating
14.
Otolaryngol Head Neck Surg ; 164(2): 300-301, 2021 02.
Article in English | MEDLINE | ID: covidwho-1125161

ABSTRACT

In the setting of COVID-19 (coronavirus disease 2019)-associated moderate and severe acute respiratory distress, persistently hypoxemic patients often require prone positioning for >16 hours. We report facial pressure wounds and ear necrosis as a consequence of prone positioning in patients undergoing ventilation in the intensive care unit in a tertiary medical center in New York City.


Subject(s)
COVID-19/therapy , Facial Injuries/etiology , Patient Positioning/adverse effects , Pressure Ulcer/etiology , Prone Position , Respiration, Artificial/adverse effects , COVID-19/complications , Critical Care , Ear/pathology , Facial Injuries/pathology , Humans , Necrosis , Pressure Ulcer/pathology
15.
Intensive Care Med ; 47(2): 222-224, 2021 02.
Article in English | MEDLINE | ID: covidwho-1086555
16.
Ann Palliat Med ; 10(1): 3-9, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1063562

ABSTRACT

BACKGROUND: COVID-19 is rapidly transmitted and has aroused enormous concern globally. This study aimed to investigate the effect of hydrocolloid dressing combined with 3M Cavilon No-Sting Barrier Film on the prevention of facial pressure injury in medical staff tasked with preventing and controlling COVID-19. METHODS: This was a self-controlled study. Medical staff who treated patients with COVID-19 infection in isolation wards from 6 January to 2 February, 2020, were selected to participate. Phase I was defined as the first 2 weeks of medical personnel entering the isolation ward, with phase II being the following 2 weeks. In phase I, medical workers only used hydrocolloid dressing on their faces, and in phase II, they used both hydrocolloid dressing and 3M Cavilon No-Sting Barrier Film. RESULTS: A total of 116 medical workers were selected as research subjects. The average facial local temperature in phase I was higher than that in phase II from the baseline (day 1) to the end of the study (day 14); however, there was no statistically significant difference (P>0.05). The incidence of facial pressure injury in phase II was lower than that in phase I (P<0.05); the facial skin comfort level among medical staff in phase II was higher than that in phase I (P<0.05). CONCLUSIONS: Hydrocolloid dressing combined with 3M Cavilon No-Sting Barrier Film for facial skin care can effectively reduce the incidence of facial pressure injury and can improve skin comfort level while ensuring isolation and a protective effect.


Subject(s)
Bandages, Hydrocolloid , Eye Protective Devices/adverse effects , Facial Injuries/prevention & control , Masks/adverse effects , Medical Staff, Hospital , Pressure Ulcer/prevention & control , Adult , COVID-19/epidemiology , China/epidemiology , Facial Injuries/etiology , Female , Humans , Male , Pandemics , Pressure Ulcer/etiology , Skin Temperature
17.
Laryngoscope ; 131(7): E2139-E2142, 2021 07.
Article in English | MEDLINE | ID: covidwho-1001948

ABSTRACT

OBJECTIVE/HYPOTHESIS: This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID-19 patients as well as to characterize the location of injuries and treatments provided. METHODS: This was a retrospective chart review of 263 COVID-19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two-tailed t-test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. RESULTS: Overall, 143 COVID-19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). CONCLUSIONS: Facial pressure injuries occur with high incidence in patients with COVID-19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2139-E2142, 2021.


Subject(s)
COVID-19/therapy , Facial Dermatoses/etiology , Facial Injuries/etiology , Patient Positioning/adverse effects , Pressure Ulcer/etiology , Prone Position , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies
18.
J Plast Reconstr Aesthet Surg ; 74(9): 2141-2148, 2021 09.
Article in English | MEDLINE | ID: covidwho-987177

ABSTRACT

BACKGROUND: In the context of the COVID-19 pandemic, prone position (PP) has been frequently used in the intensive care units to improve the prognosis in patients with respiratory distress. However, turning patients to prone imply important complications such as pressure ulcers. The aim of this paper is to describe the prevalence and characteristics of prone-positioning pressure sores (PPPS) and analyze the related risk factors. METHODS: A case-control study was performed in Gregorio Maranon hospital in Madrid during the COVID-19 pandemic between April and May 2020. We enrolled 74 confirmed COVID-19 patients in critical care units with invasive mechanical ventilation who were treated with pronation therapy. There were 57 cases and 17 controls. Demographic data, pronation maneuver characteristics and PPPS features were analyzed. RESULTS: In the case group, a total number of 136 PPPS were recorded. The face was the most affected region (69%). Regarding the severity, stage II was the most frequent. The main variables associated with an increased risk of PPPS were the total number of days under pronation cycles, and PP maintained for more than 24 h. The prealbumin level at admission was significantly lower in the case group. All of the ulcers were treated with dressings. The most frequent acute complication was bleeding (5%). CONCLUSIONS: According to our study, PPPS are related to the characteristics of the maneuver and the previous nutritional state. The implementation of improved positioning protocols may enhance results in critical patient caring, to avoid the scars and social stigma that these injuries entail.


Subject(s)
COVID-19/therapy , Critical Care/methods , Patient Positioning/adverse effects , Pressure Ulcer/etiology , Adult , Aged , COVID-19/complications , Case-Control Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Positioning/methods , Pressure Ulcer/diagnosis , Pressure Ulcer/epidemiology , Prevalence , Prone Position , Respiration, Artificial , Risk Factors , Severity of Illness Index , Spain
19.
Wound Repair Regen ; 29(1): 183-188, 2021 01.
Article in English | MEDLINE | ID: covidwho-936859

ABSTRACT

Device-related pressure injury (DRPI) is a serious problem that is affecting professionals working on the front lines against COVID-19 due to the prolonged use of personal protective equipment (PPE). In addition to the physical and psychological integrity of professionals, these injuries can compromise the quality of care. Therefore, using technologies to prevent this adverse effect is an urgent matter. This is a parallel two-arm randomized clinical trial without the use of a control group to compare the use of foam and extra-thin hydrocolloid in preventing DRPI associated with the use of PPE by health professionals working on the front lines against coronavirus. In total, 88 professionals were divided into two groups: foam and hydrocolloid. Data were collected using two instruments and related to demographic and professional characteristics and skin evaluation. Each volunteer received one of the dressings, both with the same dimensions and arranged over similar regions, and data were gathered at baseline and after 6 or 12 hours. Descriptive and inferential analytic statistical methods were used; the significance level adopted was 5%. No participant developed DRPI, but four areas with hyperemia were observed in the foam group (two in the forehead, one in the cheeks, and one in the nose bridge), as well as four areas with hyperemia in the hydrocolloid group (two in the nose bridge, one in the right ear, and one in the left ear). There was no difference between the groups regarding skin conditions and discomfort (P > .05). The average cost obtained was $ 5.8/person and $ 4.4/person in the foam group and the hydrocolloid group, respectively, considering the dressing measurements. The results show that foam and extra-thin hydrocolloid were effective in preventing DRPI associated with the use of PPE.


Subject(s)
Bandages, Hydrocolloid , COVID-19/epidemiology , Health Personnel , Pandemics , Personal Protective Equipment/adverse effects , Pressure Ulcer/prevention & control , Adult , COVID-19/therapy , Female , Follow-Up Studies , Humans , Male , Pressure Ulcer/etiology , SARS-CoV-2 , Wound Healing
20.
J Stomatol Oral Maxillofac Surg ; 122(6): 625-628, 2021 12.
Article in English | MEDLINE | ID: covidwho-838090

ABSTRACT

Pressure ulcers of the lip constitute a rare entity faced by plastic surgeons and there is a relatively paucity of data regarding optimal management. In this study we present one case of upper lip pressure ulcer related to prone intubation for respiratory distress due to SARS-CoV-2 infection, treated with surgical excision and reconstruction. We also performed a review of the literature to identify other studies on pressure lip ulcers. Six studies were considered relevant. Conservative management constitutes the most common method of treatment; however, little is known about the aesthetic, and functional morbidity related to either surgical or non-surgical treatments.


Subject(s)
COVID-19 , Pressure Ulcer , Humans , Lip/surgery , Pressure Ulcer/diagnosis , Pressure Ulcer/etiology , SARS-CoV-2
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