Wound Bed Preparation 2021 Sibbald, R Gary; Elliott, James A; Persaud-Jaimangal, Reneeka ...
Advances in skin & wound care,
04/2021, Letnik:
34, Številka:
4
Journal Article
Recenzirano
Odprti dostop
To present the 2021 update of the Wound Bed Preparation paradigm.
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest ...in skin and wound care.
After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.
PURPOSE:The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients.
TARGET ...AUDIENCE:This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
OBJECTIVES:After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF.
ABSTRACTTo develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories(1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio OR, 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners—the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidence-based practice to patients.
Acute Skin Failure in the Critical Care Patient Delmore, Barbara; Cox, Jill; Smith, Daniel ...
Advances in skin & wound care,
2020-April, 2020-Apr, 2020-4-00, 20200401, Letnik:
33, Številka:
4
Journal Article
Recenzirano
OBJECTIVEThe purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population.
METHODSResearchers conducted a ...retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model.
RESULTSEleven variables were significantly and independently related to ASFrenal failure (odds ratio OR, 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively.
CONCLUSIONSThe final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.
Background Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for ...improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colours/tones in education materials has been apparent in recent years.
Objective To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones.
Methods The following elements will be discussed through the lens of skin tone: 1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, 2) epidemiology of PI, 3) anatomy and physiology of the skin, 3) skin tone assessment and measurement, 4) augmented visual assessment modalities, 5) PI prevention, 6) PI healing, 7) social determinants of health, and 8) gaps in clinician education.
Conclusions This review highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially highlighted among patients with dark skin tones. Skin tone colour assessment must be standardised and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
OBJECTIVE:To evaluate the education process for the effective use of the Munro Pressure Ulcer Risk Assessment Scale by practicing perioperative staff at an urban tertiary medical center. Given that ...pressure injury formation is tied to the surgical process, there is a need for a pressure injury risk assessment scale that addresses the uniqueness of the perioperative process.
METHODS:Participants were staff who worked in the surgical admissions area, the main operating room, and the main postanesthesia care unit. The authors’ facility was 1 of 8 participants in a multisite study. Each site was required to educate staff using standard written instructions and an instructional webinar. However, sites were also encouraged to consider any other methods that would successfully engage the staff in the learning process. After the education process, staff were surveyed and asked to evaluate the educational interventions.
MAIN RESULTS:Findings indicated that the staff did not prefer written instructions alone but rather preferred a combination of different learning modalities and media to assist them in using the Munro Scale effectively.
CONCLUSIONS:This article discusses the strategies required to engage staff in the implementation process of this scale, the barriers encountered during this implementation, and the implications for perioperative nursing using this scale. The lessons learned from conducting this research provided insight into engaging and educating the adult learner in a new process.
Current pediatric pressure injury (PI) prevention measures are based on risk factors related to PI development in adults. Children offer a unique concern for PI development because their bodies are ...still developing, and their skin responds differently to external pressure.BACKGROUNDCurrent pediatric pressure injury (PI) prevention measures are based on risk factors related to PI development in adults. Children offer a unique concern for PI development because their bodies are still developing, and their skin responds differently to external pressure.To explore risk factors for the development of full-thickness PIs in children aged 21 weeks' gestation to 21 years.OBJECTIVETo explore risk factors for the development of full-thickness PIs in children aged 21 weeks' gestation to 21 years.This retrospective, observational, correlational study included 799 hospitalized children who developed a PI. The pediatric and adult PI risk factors used in the study were identified from the International Pressure Ulcer Prevention and Treatment Guideline. A stepwise multivariate logistic regression model was used.METHODSThis retrospective, observational, correlational study included 799 hospitalized children who developed a PI. The pediatric and adult PI risk factors used in the study were identified from the International Pressure Ulcer Prevention and Treatment Guideline. A stepwise multivariate logistic regression model was used.Multivariate analyses revealed that risk factors for predicting a full-thickness PI varied by age. For children aged 38 weeks to 12 months, risk factors included tissue perfusion and oxygenation: generalized edema, conditions of the OR, and nutrition deficits. For children aged 1 to 7 years, fragile skin status was a risk factor. For youth aged 8 to 21 years, the two risk factors were tissue perfusion and oxygenation: decreased oxygenation and extracorporeal membrane oxygenation. Across the total sample, extracorporeal membrane oxygenation, tissue perfusion and oxygenation: decreased oxygenation and malnutrition were risk factors for predicting a full-thickness PI.RESULTSMultivariate analyses revealed that risk factors for predicting a full-thickness PI varied by age. For children aged 38 weeks to 12 months, risk factors included tissue perfusion and oxygenation: generalized edema, conditions of the OR, and nutrition deficits. For children aged 1 to 7 years, fragile skin status was a risk factor. For youth aged 8 to 21 years, the two risk factors were tissue perfusion and oxygenation: decreased oxygenation and extracorporeal membrane oxygenation. Across the total sample, extracorporeal membrane oxygenation, tissue perfusion and oxygenation: decreased oxygenation and malnutrition were risk factors for predicting a full-thickness PI.Full-thickness PI risk factors differ among the ages of pediatric patients.CONCLUSIONSFull-thickness PI risk factors differ among the ages of pediatric patients.
At the April 2016 National Pressure Ulcer Advisory Panel (NPUAP) consensus conference, terminology and staging definitions were updated and two definitions were revised to describe pressure injuries ...(PIs) caused by medical devices or other items on the skin or mucosa. Here, the authors discuss the etiology and prevention of PIs resulting from medical and other devices, the frequency of such injuries, and the bodily sites at which they most often occur. They provide an overview of the current NPUAP guideline, highlight important risk factors, and explain why mucosal PIs cannot be staged.
GENERAL PURPOSETo review what is known about pediatric pressure injuries (PIs) and the specific factors that make neonates and children vulnerable.
TARGET AUDIENCEThis continuing education activity ...is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMESAfter participating in this educational activity, the participant should be better able to:1. Identify the scope of the problem and recall pediatric anatomy and physiology as it relates to PI formation.2. Differentiate currently available PI risk assessment instruments.3. Outline current recommendations for pediatric PI prevention and treatment.
ABSTRACTPediatric patients, especially neonates and infants, are vulnerable to pressure injury formation. Clinicians are steadily realizing that, compared with adults and other specific populations, pediatric patients require special consideration, protocols, guidelines, and standardized approaches to pressure injury prevention. This National Pressure Advisory Panel white paper reviews this history and the science of why pediatric patients are vulnerable to pressure injury formation. Successful pediatric pressure injury prevention and treatment can be achieved through the standardized and concentrated efforts of interprofessional teams.
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