Pressure ulcers in critically ill patients: incidence and associated factors

this was a prospective cohort study with 77 patients, using a clinical, metabolic assessment and the associated factors for pressure ulcer, applying the risk scales (Braden and Waterlow) and assigning ulcers to categories.

Results:

an incidence of 22% (95% CI 12.6 - 31.5), with 17 patients with 32 pressure ulcers in the sacral region (47%), and of Class I (72%). The length of stay was greater than ten days (71%), most admissions were surgical (53%) or for congestive heart failure (24%), and were high risk on the Braden Scale (59%).

Conclusion:

the study highlights the high incidence of pressure ulcers, clinical and metabolic characteristics and associated factors, as well as the outcome of death, requiring, therefore, preventive measures.

Descriptors:
Pressure Ulcer; Risk Assessment; Scales; Nursing Care; Incidence

Variables	With pressure ulcer		Without pressure ulcer		P value
Variables	n	%	n	%
Age
< 60	8	47	32	53	0.785
> 60	9	53	28	47
Sex
Female	7	41	32	53	0.421
Male	10	59	28	47
Skin color
White	14	82	39	65	0.24
Non-white	3	18	21	35
Unit
Intermediate unit – IU	2	12	14	23	0.499
Intensive care unit – ICU	15	88	46	77

Variable	With pressure ulcer		Without pressure ulcer		P value
Variable	n	%	n	%
Length of stay
< 10 days	5	29	47	78	0.000
≥ 10 days	12	71	13	22
Type of admission
Surgical	9	53	44	73	0.141
Clinical	8	47	16	27
Clinical diagnosis
Gastrointestinal	8	47	31	51	0.427
Cardiorespiratory	5	29	18	30
Urogynecological	1	6	4	7
Rheumatic/Hematologic	2	12	4	7
Neuroinfectious	1	6	3	5
BMI
Normal (18.5 – 24.9)	6	35	27	45	0.463
More than Average (25 – 29.9)	4	24	18	30
Obese (>30)	3	17	9	15
Below the average (<18.5)	4	24	6	10
Diabetes mellitus
Yes	4	24	11	18	0.73
No	13	76	49	82
Smoking
Yes	3	18	20	33	0.248
No	14	82	40	67
CHF
Yes	4	24	1	2	0.008
No	13	76	59	98
Type of diet
None	10	59	40	68	0.84
Enteral	6	35	14	23
Oral	1	6	4	7
Parenteral	0	0	2	3
Mechanical ventilation
Yes	6	35	16	27	0.548
No	11	65	44	73
Noradrenalin
Yes	5	29	7	12	0.123
No	12	71	53	88
Sedation
Yes	3	18	8	13	0.699
No	14	82	52	87
Outcome
Hospital discharge	7	41	51	85	0.001
Death	10	59	9	15
Hemoglobin
> 8.0 g/100 ml	15	88	53	88	1.0
< 8.0 g/100 ml	2	12	7	12
Hematocrit
> 24%	14	82	52	87	0.699
< 24%	3	18	8	13
Lymphocyte cell count
> 1.200/mm³	5	29	14	23	0.751
< 1.200/mm³	12	71	46	77
Albumin
>3.5 g/dl	1	6	12	20	0.276
<3.5 g/dl	16	94	48	80
Transferrin
> 100 mg/dl	7	41	30	50	0.54
< 100 mg/dl	10	59	30	50

Variable	With ulcer		Without ulcer		P value
Variable	n	%	n	%
Risk level
Waterlow
Risk (10-14)	5	29	27	45	0.397
High risk (15-19)	9	53	21	35
Very high risk (≥ 20)	3	18	12	20
Braden
Risk (> 16)	1	6	9	15	0.003
Moderate risk (12-16)	6	35	41	68
High risk (≤11)	10	59	10	17

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Andressa Tomazini Borghardt. E-mail: andressatomazini@yahoo.com.br