Pressure ulcers related to prone positioning: a pandemic amidst a pandemic.

OBJECTIVE: To explore the epidemiology and risk factors associated with the development of pressure ulcers (PUs) in patients receiving prone positioning (PP) ventilatory therapy; to compare the inflammatory status of patients who develop PUs with those who do not; and to describe the experience and useful findings that have allowed us to improve the management of these patients to reduce the incidence of PUs. METHOD: An observational, descriptive and longitudinal study was conducted, where sociodemographic and laboratory data were collected from patients who were hospitalised and required PP ventilatory therapy in critical care areas (CCA) during the months of May-October 2020. RESULTS: From the total number of patients who required PP during their CCA stay (n=240), 202 (84.2%) developed a PU. The four most frequent areas where a PU appeared were: the head and neck (n=115); the pinna (n=21); the torso (n=21); and the lower limbs (n=21). Patients who developed PU were more frequently males with higher initial levels of creatinine phosphokinase and ferritin. The incidence for each month of follow-up decreased from 8.3% to 5.8%. CONCLUSION: Regardless of the intervention, a multidisciplinary approach is required to optimise the prevention and treatment of these wounds. While PUs are often the result of other medical conditions or poor health status in general, the vast majority of PUs are avoidable.

[Adverse cutaneous reactions to drugs]. / Reacciones cutáneas adversas a medicamentos.

Adverse cutaneous reactions to drugs are any undesirable change in the structure or function of the skin. These are among the adverse side effects to common drugs. The most commonly implicated drugs are antibiotics and anticonvulsants. Cutaneous clinical manifestations are diverse ranging from mild or moderate reactions, such as urticaria and maculopapular rash, to severe cutaneous adverse reactions (SCAR), which are known due to their high morbidity and mortality (among these: Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). The clinical pattern, etiology, prognosis and treatment differ among these skin reactions, which is why it is necessary a clear diagnosis based on a comprehensive clinical examination, skin biopsy, and specific laboratory tests. The therapeutic options depend on the clinical diagnosis. For all reactions, a symptomatic and adequate supportive therapy is necessary; in some cases, a systemic immunomodulatory therapy can be useful.

Las reacciones cutáneas adversas a medicamentos son cualquier cambio indeseable en la estructura o función de la piel. Estas figuran entre los efectos adversos secundarios a medicamentos más comunes. Los grupos de fármacos más frecuentemente implicados son los antibióticos y los anticonvulsivantes. Las manifestaciones clínicas cutáneas son diversas y abarcan desde las reacciones leves o moderadas, como es el caso de la urticaria y el exantema maculopapular, hasta las reacciones cutáneas adversas severas, que son conocidas por su alta morbilidad y mortalidad, por ejemplo, el síndrome de Stevens Johnson, la necrosis epidérmica tóxica (NET) y el síndrome de hipersensibilidad, denominado reacción a fármacos con eosinofilia y síntomas sistémicos (DRESS). El patrón clínico, la etiología, el pronóstico y el tratamiento difieren entre estas reacciones cutáneas, por lo que es necesario un diagnóstico claro basado en un examen clínico exhaustivo, biopsia de piel y estudios de laboratorio. Las opciones terapéuticas dependen del diagnóstico clínico. Para todas las reacciones es necesario un tratamiento adecuado de soporte; en algunos casos puede utilizarse terapia inmunomoduladora.