Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency
Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency
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DOI：
10.12968/jowc.2020.29.6.312
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发表时间：
2020-06-01
影响因子：
1.9
通讯作者：
O'Connor, Tom
中科院分区：
文献类型：
--
作者：
Moore, Zena;Patton, Declan;O'Connor, Tom
目的：压力性溃疡（PU）涉及由于长时间的压力和剪切力导致的皮肤和下层组织的破坏。这些溃疡是痛苦的，并显着降低一个人的生活质量。PU也是昂贵的管理和负面影响的实现成本效益，高效的care delivery.Method：俯卧位是一种姿势疗法，旨在通过增加氧合水平，以提高呼吸功能。在现代临床实践中，俯卧位通气适用于严重急性呼吸窘迫综合征患者。然而，尽管俯卧位通气在呼吸功能方面具有优势，但有几项研究检查了俯卧位通气的并发症，并将PU（面部PU以及身体其他承重区域的PU）确定为已经处于不稳定医疗状况的患者的常见并发症。国际数据表明，高达57%的俯卧位护理患者发生PU。本临床综述的目的是确定和审查循证建议，以促进预防性干预措施的选择和应用，旨在减少俯卧位通气患者的PU发展。鉴于目前的COVID-19危机，这项审查是及时的，因为患有COVID-19的重症监护病房（ICU）患者需要俯卧位通气，其水平与一般重症监护人群不成比例。高达28%因严重COVID-19确诊感染而入住ICU的患者以俯卧位接受护理。本次审查的范围仅限于成年individuals.Results：皮肤评估应进行前俯卧和以下定位患者回到仰卧位。虽然保持皮肤清洁和保湿是必不可少的，使用pH平衡的清洁剂，但在支持保湿剂类型的证据方面存在不一致。除了重新定位外，建议使用定位装置来减轻面部和身体上的压力点。此外，使用敷料，如水胶体，透明膜和硅胶可能有利于减少面部皮肤breakdown.Conclusion：鉴于PU预防在这一队列的患者的重要性，采取有针对性的预防策略，包括皮肤评估和护理，卸载和压力重新分配，和敷料的预防可能有助于减少这些在很大程度上可预防的伤口的发病率和患病率。利益声明：作者没有利益冲突。
Objective: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery.Method: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only.Results: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown.Conclusion: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds. Declaration of interest: The authors have no conflicts of interest to declare.