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Risk Factors for Medical Device-related Oral Mucosa Pressure Ulcer Development of Intubated Patients in Adult Intensive Care Unit

성인 중환자실에서 인공기도를 가진 환자의 의료기기 관련 구강점막욕창 발생의 위험요인

  • Received : 2020.09.23
  • Accepted : 2020.11.29
  • Published : 2020.11.30

Abstract

Purpose: This study was performed to identify the risk factors for oral mucosa pressure ulcer development in intubated patients in adult intensive care unit. Methods: Comparative descriptive study design using prospective observational design and medical record review was used. The inclusion criteria of case was that a) patients of 18 years in their age, b) patients with endotracheal tube. Data of 34 patients were analysed. Descriptive statistics, chi-square test, Fisher's exact test, Mann-whitney test, Spearman's rho correlation coefficients, and multiple logistic regression analysis were used. Resampling methods such as bootstrap was used in this study because of small number of patients. Results: Oral mucosa pressure ulcer developed in 44.1% of the intubated patients. The risk factors of oral mucosa pressure ulcer were steroid use, biteblock use and serum albumin level. Compared to the non-user of steroid, user of steroid had 32.59 times (95% CI: 1.47-722.44) higher risk of developing oral mucosa pressure ulcer. The user of biteblock had 18.78 times (95% CI: 1.00-354.40) and albumin level had 0.03 times (95% CI: 0.00-0.80) higher risk of oral mucosa pressure ulcer incidence. Conclusion: Based on the results of this study, tailored pressure relief strategies considering sex and therapeutic condition should be provided to decrease oral mucosa pressure ulcer.

Keywords

References

  1. The National Pressure Ulcer Advisory Panel. Mucosal pressure ulcers: an NPUAP position statement [Internet]. Washington DC: The National Pressure Ulcer Advisory Panel; 2008 [cited 2020 0825]. Available from: http://www.npuap.org/wp-content/uploads/2012/01/Mucosal_Pressure_Ulcer_Position_Statement_final.pdf.
  2. Haugen V. Prevention of pressure ulcers due to medical devices. Perspectives. 2015;10(3):1-11.
  3. Holden-Mount S, Sieggreen M. Medical-device related pressure ulcers: paediatrics & adults. presented february 20, 2015, at the 2015 NPUAP national biennial conference, orlando, florida. Available from http://www.npuap.org/wp-content/uploads/2015/02/5.-Medical-Devices-S-Holden-Mount-and-M-Sieggreen1.pdf.
  4. Barakat-Johnson M, Lai M, Wand T, Li M, White K, Coyer F. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. Journal of Wound Care. 2019;28(8):512-521. http://doi.org/10.12968/jowc.2019.28.8.512
  5. Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, Nogueira PC, Lin FF. Incidence and prevalence of pressure injuries in adult intensive care patients: A systematic review and meta-analysis. Read Online: Critical Care Medicine | Society of Critical Care Medicine. 2018;46(11):e1074-e1081. http://doi.org/10.1097/CCM.0000000000003366
  6. Rolls K, Jones S, Power D, Cook S, Flood K, Hennessy C, et al. Pressure injury prevention for critically ill adults: a clinical practice guideline. Chatswood, NSW: Agency for Clinical Innovation NSW Government. 2014. p. 47.
  7. Koo MJ, Sim YA, Kang IS. Risk factors of medical device-related pressure ulcer in intensive care units. Journal of Korean Academy Nursing. 2019;49(1):36-45. https://doi.org/10.4040/jkan.2019.49.1.36
  8. Tayyib N, Coyer F, Lewis P. Pressure injury prevention in a saudi arabian intensive care unit: Registered nurse attitudes toward prevention strategies and perceived facilitators and barriers to evidence implementation. Journal of Wound Ostomy & Continence Nursing. 2016;43(4):369-374. http://doi.org/10.1097/WON.0000000000000245
  9. Kim JH, Lee JY, Lee EH. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of Nursing Management. 2019;00:1-9. http://doi.org/10.1111/jonm.12928
  10. Sin JH. Characteristics and risk factors of pressure ulcer in patients admitted to medical intensive care unit [master's thesis]. Daegu: Kyungpook National University; 2012. p. 1-32.
  11. Shin KR, Kim MY, Kang YH, Jung DY, Cha JY, Lee E, et al. Facility and nursing factors influence on pressure ulcer occurrence among patients at risk for pressure ulcer in long-term care hospitals. Journal of Korean Gerontological Nursing. 2012;14(1):30-39.
  12. Kwak HR, Kang J. Pressure ulcer prevalence and risk factors at the time of intensive care unit admission. Korean Journal of Adult Nursing. 2015;27(3):347-357. https://doi.org/10.7475/kjan.2015.27.3.347
  13. Cox J. Pressure ulcer development and vasopressor agents in adult critical care patients: a literature review. Ostomy Wound Management. 2013;59(4):50-54.
  14. Nedergaard HK, Haberlandt T, Toft P, Jensen HI. Pressure ulcers in critically ill patients-Preventable by non-sedation? a substudy of the NONSEDA-trial. Intensive and Critical Care Nursing. 2018;44(1):31-35. https://doi.org/10.1016/j.iccn.2017.09.005
  15. Chen H, Shen W, Xu Y, Zhang Q, Wu J. Perioperative corticosteroids administration as a risk factor for pressure ulcers in cardiovascular surgical patients: a retrospective study. International Wound Journal. 2015;12(5):581-585. https://doi.org/10.1111/iwj.12168
  16. Choi BK, Kim MS, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: a prospective observational study. Journal of Tissue Viability. 2020;29(4):252-257. https://doi.org/10.1016/j.jtv.2020.06.002
  17. Curry K, Kutash M, Chambers T, Evans A, Holt M, Purcell S. A prospective, descriptive study of characteristics associated with skin failure in critically ill adults. Ostomy Wound Management. 2012;58(5):36-38, 40-43.
  18. Ma JZ, Ebben J, Xia H, Collins AJ. Hematocrit level and associated mortality in hemodialysis patients. Journal of the American Society of Nephrology. 1999;10(3):610-619. https://doi.org/10.1681/ASN.V103610
  19. Corniello AL, Moyse T, Bates J, Karafa M, Hollis C, Albert NM. Predictors of pressure ulcer development in patients with vascular disease. Journal of Vascular Nursing. 2014;32(2):55-62. https://doi.org/10.1016/j.jvn.2013.07.002
  20. Kim CH, Kim MS, Kang MJ, Kim HH, Park NJ, Jung HK. Oral mucosa pressure ulcers in intensive care unit patients: a preliminary observational study of incidence and risk factors. J Tissue Viability. 2019;28(1):27-34. https://doi.org/10.1016/j.jtv.2018.11.002
  21. Reaper S, Green C, Gupta S, Tiruvoipati R. Inter-rater reliability of the reaper oral mucosa pressure injury scale (ROMPIS): a novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa. Australian Critical Care. 2017;30(3):167-171. https://doi.org/10.1016/j.aucc.2016.06.003
  22. Bautista D, Arana E, Marti-Bonmati L, Paredes R. Validation of logistic regression models in small samples: application to calvarial lesions diagnosis. Journal of Clinical Epidemiology. 1999;52(3):237-241. https://doi.org/10.1016/s0895-4356(98)00165-6
  23. Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): Explanation and elaboration. Annals of Internal Medicine. 2015;162(1):W1-W73. https://doi.org/10.7326/M14-0698
  24. Rashvand F, Shamekhi L, Rafiei H, Nosrataghaei M. Incidence and risk factors for medical device related pressure ulcers: the first report in this regard in iran. International Wound Journal. 2020;17(2):436-442. https://doi.org/10.1111/iwj.13290
  25. Hampson J, Green C, Stewart J, Armitstead L, Degan G, Aubrey A, et al. Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the intensive care unit: a retrospective observational study. BMC nursing. 2018;17(1):4. https://doi.org/10.1186/s12912-018-0274-2
  26. Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: a systematic review and meta-analysis. International Journal of Nursing Studies. 2019;92:109-120. https://doi.org/10.1016/j.ijnurstu.2019.02.006
  27. Hanonu S, Karadag A. A prospective, descriptive study to determine the rate and characteristics of and risk factors for the development of medical device-related pressure ulcers in intensive care units. Ostomy Wound Management. 2016;62(2):12-22.
  28. Brincat M, Moniz CF, Studd JW, Darby AJ, Magos A, Cooper D. Sex hormones and skin collagen content in postmenopausal women. British Medical Journal. 1983;287(6402):1337-1338. https://doi.org/10.1136/bmj.287.6402.1337
  29. Kim JM, Shin SC, Park GC, Lee JC, Jeon YK, Ahn SJ, et al. Effect of sex hormones on extracellular matrix of lamina propria in rat vocal fold. The Laryngoscope. 2020;130(3):732-740. https://doi.org/10.1002/lary.28086
  30. Kim JM, Park SH. Risk and benefit of steroid therapy. The Korean Journal of Medicine. 2009;77(3):298-303.
  31. Amrani G, Gefen A. Which endotracheal tube location minimises the device related pressure ulcer risk: the centre or a corner of the mouth? International Wound Journal. 2020;17(2):268-276. https://doi.org/10.1111/iwj.13267
  32. North of England Cricital Care Network, BPG 02: Endo-tracheal tube care. 2017 [cited 2020 0529]; Available from: https://www.noeccn.org.uk/resources/Documents/Benchmarks%20Guidelines/Guideline%20-%20New/BPG%2002%20-%20ETT%20Care%20Final.pdf.
  33. Lee HN, Park JS. Nutrition-related factors predicted pressure ulcers in intensive care unit patients. Journal of Korean Academy Fundamental Nursing. 2014;21(4):413-422. http://dx.doi.org/10.7739/jkafn.2014.21.4.413
  34. Serra R, Caroleo S, Buffone G, Lugarà M, Molinari V, Tropea F, et al. Low serum albumin level as an independent risk factor for the onset of pressure ulcers in intensive care unit patients. International Wound Journal. 2014;11(5):550-3. https://doi.org/10.1111/iwj.12004
  35. Neiva GP, Carnevalli JR, Cataldi RL, Furtado DM, Fabri RL, Silva PS. Hematological change parameters in patients with pressure ulcer at long-term care hospital. Einstein (Sao Paulo). 2014;12(3):304-309. https://doi.org/10.1590/S1679-45082014AO3034
  36. Cho E, Chin DL, Kim S, Hong OS. The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship. 2016;48(1):74-82. https://doi.org/10.1111/jnu.12183
  37. Ryu, JM. Development and effects of a clinical decision support system for pressure ulcers prevention nursing using deep learning [dissertation]. Busan: Pukyong National University; 2020.
  38. Black J, Alves P, Brindle CT, Dealey C, Santamaria N, Call E, et al. Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices. International Wound Journal. 2015;12(3):322-327. https://doi.org/10.1111/iwj.12111
  39. Parish LC, Dryjski M, Cadden S, Versiva® XC Pressure Ulcer Study Group. Prospective clinical study of a new adhesive gelling foam dressing in pressure ulcers. International Wound Journal. 2008;5(1):60-67. https://doi.org/10.1111/j.1742-481X.2007.00428.x
  40. Lupianez-Perez I, Uttumchandani SK, Morilla-Herrera JC, Martin-Santos FJ, Fernandez-Gallego MC, Navarro-Moya FJ, et al. Topical olive oil is not inferior to hyperoxygenated fatty aids to prevent pressure ulcers in high-risk immobilised patients in home care. results of a multicentre randomised triple-blind controlled non-inferiority trial. PloS one. 2015;10(4):e0122238. https://doi.org/10.1371/journal.pone.0122238