[Incidence and risk factors associated with the development of pressure ulcers in an Italian general intensive care unit]. / Incidenza e fattori di rischio associatiallo sviluppo di lesioni da pressione in una terapia intensiva generale italiana.

. Incidence and risk factors associated with the development of pressure ulcers in an Italian general intensive care unit. INTRODUCTION: Pressure ulcers (PU) represent one of the most frequent adverse event in intensive care units (ICU). Critical patients are at higher risk of developing a PU, with an incidence between 3.3-39.3%. AIM: To assess the incidence and risk factors for developing PUs in a general ICU of an Italian University hospital. METHODS: Retrospective observational study on a sample of 122 patients admitted to a general intensive care unit, from January to December 2015, with a length of ICU stay > 5 days. PUs were stadied according to the National Pressure Ulcer Advisory Panel. RESULTS: One hundred and twenty two patients were enrolled. The incidence of PUs was 33%, and the incidence rate was 23 PUs for 1.000 days of ICU stay; 29% of PUs were of stage I, 56% of stage II, 8% stage III and 6% stage IV. PUs mainly affected the sacrum (21%) with a very low incidence in the heels (1.6%). Despite several factors were associated to the development of PUs (being female, Sequential Organ Failure Assessment, length of stay, mechanical ventilation > 72 hours, administration of dobutamine, Admission pO 2/FiO2 ratio, mean Braden during ICU stay and admission diagnosis) only ICU lenght of day remained statistically significant. CONCLUSIONS: The incidence of PUs is comparable to other recent studies. Many factors are potentially involved in the onset of PUs. Identifying these factors can help nurses to plan interventions to prevent their development.

[Level of sedation level and modifications of vital signs during hygienic care in patients admitted to an intensive care unit]. / Livello di sedazione e alterazioni dei parametri vitali durante le cure igieniche nei pazienti ricoverati in una terapia intensiva polivalente.

INTRODUCTION: Hygienic care practices may represent a source of stress for intensive care patients. AIM: To identify the hygienic care practices more involved in changes of vital signs and the association to the level of sedation. METHODS: Prospective observational study of eleven patients admitted to a general intensive care unit, observed for three consecutive hygiene care morning practices. A protocol for standardizing hygiene practices was adopted. Vital signs were recorded on an electronic database at the beginning of each of the following phase: before the start of hygiene, of mouth cleaning, of sponge bath, positioning of bedpan, first and second side rotation, change of position of endotracheal tube and replacement of tapes, and at the end of hygiene. RESULTS: 29 events of hygiene practices were observed in the 11 patients included in the study (the measurements of three events were discarded). Significant vital signs alterations were induced mainly by the rotation and change of position of the orotracheal tube. Significant correlations were observed between changes in Heart Rate and Bispectral Index (BIS) (coefficient of 0.345; P: 0.329), between BIS and systolic arterial blood pressure (0.774, P: 0.009), BIS and Tidal Volume (-0.569, P: 0.086), and BIS and Respiratory Rate (0.707, P: 0.022). CONCLUSIONS: The hygienic care in intensive care patients may negatively impact on vital signs. Some nursing manoeuvres cause variations of the vital signs also related to changes in the state of consciousness caused by possible defects or excesses of sedation. The sedation level, during hygienic care, should be constantly monitored.