Prevalence and prognosis of hard-to-heal wounds with comorbidities in China.

OBJECTIVE: Regular retrospective analysis is necessary for potential improvement in clinical practice for the treatment of hard-to-heal wounds. Comorbidities and outcomes have demonstrated spatial and temporal diversity, emphasising the importance of updates in epidemiology. The complexity of healing hard-to-heal wounds has long been known, and so we sought evidence-based improvement on the current principles of treatment. METHOD: Demographic and clinical information of patients from the WoundCareLog database was collected. Patients who met the inclusion criteria and completed follow-up after treatment were included. Comorbidities were diagnosed and classified into eight categories based on ICD-10. We compared the demographic and aetiological characteristics between patients with and without comorbidities by t-test and Chi-squared test. The impact of comorbidities on wound healing were evaluated with a multivariate Cox model. RESULTS: A total of 2163 patients met the inclusion criteria and were enrolled, of whom 37.0% were aged 61-80 years, 36.0% were aged 41-60 years and 60.8% were male. The lower extremities and buttocks were the most commonly affected areas with hard-to-heal wounds. Non-traumatic wounds accounted for 66.6% of cases, and infection, pressure and diabetes were the most common causes. Paralysis and diabetes were the most important factors which led to a prolonged healing process and inferior clinical outcomes. CONCLUSION: Comorbidities of hard-to-heal wounds were treated as separate contributors and their weighted effect on outcome was calculated through correlation analysis. Paralysis and diabetes were the most unfavourable comorbidities affecting the treatment of non-traumatic hard-to-heal wounds. Our study highlighted the priority of comorbidity treatment through data-driven approaches. It provides potential value in developing better public health strategies and preventive medicine.

[The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury].

OBJECTIVE: To observe the impact of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in mechanically ventilated patients with severe craniocerebral injury. METHODS: A prospective, interventional, self-control study was conducted. Thirty severe craniocerebral injury patients with central respiratory failure were enrolled. The changes in CVP, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation [SpO2] were monitored at different PEEP levels [0, 3, 6, 9, 12, 15 cm H2O; 1 cm H2O=0.098 kPa] during mechanical ventilation and after weaning of mechanical ventilation. The influences of PEEP and its discontinuance on haemodynamics and oxygenation were analyzed. RESULTS: The values of CVP [cm H2O] were increased when PEEP increased (from 7.9±3.1 to 13.1±3.7), a linear correlation was found (R=0.509, P=0.000), and linear regression equation was CVP [cm H2O]=7.774+0.368×PEEP [cm H2O]; CVP was elevated about 0.368 cm H2O when PEEP increased 1 cm H2O. CVP values significantly decreased during discontinuance of mechanical ventilation, as compared to those measured at different PEEP levels during mechanical ventilation (F=24.429, P=0.000). The values of MAP, HR and SpO2 showed no significant change with increase of PEEP levels [MAP (mm Hg, 1 mm Hg=0.133 kPa): from 81.6±10.4 to 85.6±10.6; HR (beats per minute): from 79.9±13.5 to 88.1±15.4; SpO2: from 0.968±0.036 to 0.975±0.033, all P>0.05] in mechanically ventilated patients, but discontinuance of mechanical ventilation could significantly increase the levels of MAP and HR (95.3±8.4 and 94.9±10.3, respectively) and lower SpO2 levels (0.928±0.036, all P=0.000). CONCLUSIONS: CVP values were overestimated during an increase in PEEP in mechanically ventilated patients with severe craniocerebral injury. CVP was increased about 0.368 cm H2O following an increase of PEEP of 1 cm H2O, whereas the values of MAP, HR and SpO2 showed no significant change with increase in PEEP levels. This study could offer a theoretical base in the correct assessment of CVP values at different PEEP levels without discontinuation of mechanical ventilation.