Early Detection and Wound Monitoring of Pressure Ulcers

压疮的早期检测和伤口监测

• 批准号: 8525180
• 负责人: Royce W Johnson
• 金额: $ 17.51万
• 依托单位: APPLIED NANOTECH, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-18 至 2014-08-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8525180
• 关键词: Acute; Address; Administrator; Admission activity; Affect; Amputation; Analytical Chemistry; Biological Markers; Biomechanics; Businesses; California; Caring; Cessation of life; Classification; Clinical; Communities; Contracts; Coupled; Decubitus ulcer; Detection; Development; Devices; Direct Costs; Early Diagnosis; Ensure; Expenditure; Face; Facilities and Administrative Costs; Failure; Gases; Health Care Costs; Health care facility; Healthcare; Healthcare Systems; Hip Fractures; Hospitals; Housing; Human; Incontinence; Infection; Injury; Institution; Intensive Care Units; Intervention; Ions; Judgment; Lead; Long-Term Care; Measurable; Membrane; Metabolism; Methodology; Methods; Microclimate; Modeling; Monitor; Motivation; Nanotechnology; Nursing Process; Nutritional status; Outcome; Oxidative Stress; Pathology; Patients; Pattern; Performance; Phase; Physiological; Positioning Attribute; Pre-Clinical Model; Predictive Value; Preparation; Process; Research; Risk; Sampling; Sepsis; Services; Signal Transduction; Site; Skin; Small Business Innovation Research Grant; Specificity; Spectrometry; Staging; Stress; Surface; System; Technology; Testing; Time; Tissues; Translations; Ulcer; Universities; Work; base; bench to bedside; clinical care; commensal microbes; commercialization; cost; design; economic impact; experience; high risk; improved; instrument; instrumentation; ion mobility; medical specialties; older patient; patient home care; preference; pressure; public health relevance; screening; sensor; tool; wasting; wound

DESCRIPTION (provided by applicant): Pressure ulcers are a serious problem in clinical care. They are caused by immobility, moisture, and patient pathologies (Reddy 2006). They cause many poor outcomes including infection and amputation, and costs of $1B in the US and $3B-$5B worldwide (Salcido 2012, Russo 2006). Nursing processes use repositioning, skin checks, specialty support surfaces, and incontinence management. Risk scales such as those of Norton and Braden (NPUAP 1989, Bergstrom 1987) are currently used to identify patients at higher risk. While these processes and scales are valid, their ability to predict and manage ulcer occurrence are modest at best (Schoonhoven 2002) and pressure ulceration remains a significant healthcare cost and cause of poor outcomes. Skin metabolites are known to contain volatiles produced by tissue metabolism and commensal bacteria of the skin (Gallagher 2008). Many of these are markers of oxidative stress (Pabst 2007, Aghdassi 2000, Dumelin 1977); therefore multiple markers are anticipated to be affected by the physiologic stresses which lead to pressure ulceration and to show unique spectral patterns for injury vs. those of intact skin. In order to ensure that ulceration-specific signals are sampled, in preference to systemic or environmental signals, it is important to sample and analyze markers obtained at high-risk skin sites. This will be done by use of polydimethylsilicone (PDMS) membrane methods (Thomas 2010) coupled with a proprietary ion-mobility sensor technology developed by Applied Nanotech, Inc. (EZKnowz"). An inexpensive system will be developed for early detection of pressure ulceration by profiling of volatile markers with a portable, bedside analysis product. The near-real-time results of the analyses will be provided to the clinical team to guide the use of interventions. Specific Aim 1 is to develop and optimize VOC trapping methods with PDMS membranes. Specific Aim 2 is to develop an extraction interface and verify the biomarker analyses with the EZKnowz" technology. Specific Aim 3 is to test the feasibility of the approach in a pre- clinical model of pressure ulceration. An early-detection capability for pressure ulcers will allow for more appropriate use of interventions such as pressure relief and microclimate control surfaces or aggressive repositioning leading to better care for lower costs. One example of this is in distinguishing pre-emergent, community-acquired ulcers upon admission of a patient to a healthcare facility from those appear during in-house care. Correct classification will allow healthcare facility administrators to appropriately obtain reimbursement for treating them rather than have the ulcers classed as nosocomial ulcers, thereby losing out on reimbursement coverage. Patient outcomes will be improved by reduced ulceration rates and more timely interventions.

描述(由申请人提供)：压疮是临床护理中的一个严重问题。它们是由静止、潮湿和病人的病理引起的(Reddy 2006)。它们导致许多不良后果，包括感染和截肢，在美国造成10亿美元的损失，在全球造成30亿至50亿美元的损失(Salcido 2012，Russo 2006)。护理流程使用重新定位、皮肤检查、特殊支撑面和大小便失禁处理。目前使用Norton和Braden(NPUAP，Bergstrom，1987)的风险量表来识别风险较高的患者。虽然这些过程和量表是有效的，但它们预测和管理溃疡发生的能力充其量是适度的(Schoonhoven 2002)，压力溃疡仍然是一个重要的医疗成本和不良结果的原因。众所周知，皮肤代谢物含有由组织新陈代谢和皮肤共生细菌产生的挥发物(Gallagher，2008)。其中许多是氧化应激的标记物(Pabst 2007，Aghdassi 2000，Dumelin 1977)；因此，预计多个标记物会受到导致压疮的生理应激的影响，并显示出损伤与完整皮肤的独特光谱模式。在……里面 为了确保采集溃疡特异性信号，而不是全身或环境信号，重要的是采样和分析在高危皮肤部位获得的标记物。这将通过使用聚二甲基硅氧烷(PDMS)膜方法(Thomas 2010)和应用纳米技术公司(EZKnowz)开发的专有离子迁移率传感器技术来完成。将开发一种廉价的系统，通过使用便携式床边分析产品分析挥发性标志物来早期检测压力溃疡。分析的接近实时的结果将被提供给临床团队，以指导干预措施的使用。具体目标1是开发和优化使用PDMS膜捕获VOC的方法。具体目标2是开发提取界面并利用EZKnowz技术验证生物标记物分析。具体目标3是在压疮的临床前模型中测试该方法的可行性。对压疮的早期检测能力将允许更适当地使用干预措施，如减压和微气候控制表面或积极重新定位，从而更好地照顾更低的成本。这方面的一个例子是，在将患者送入医疗机构时区分急诊前的社区获得性溃疡与在内部护理期间出现的溃疡。正确的分类将使医疗机构管理员能够适当地获得治疗的补偿，而不是将溃疡归类为医院溃疡，从而失去报销范围。通过降低溃烂率和更及时的干预，患者的预后将得到改善。