Pressure Ulcers in ICU Patients:
Pressure ulcers have been reported across all healthcare settings, affect all age groups and are costly in terms of quality of life and health care resources. Pressure ulcers develop when persistent pressure on a bony site obstructs healthy capillary flow leading to tissue necrosis. This typically occurs over a bony prominence but can occur in any situation where blood flow to the skin is impeded. The etiology of pressure ulcers is multifactorial and although mechanical forces are the prime etiological factors, more than 100 risk factors have been identified in the literature that reduce tissue tolerance and increase patient susceptibility.
Why are ICU Patients at risk of Pressure Ulceration?
The first priority for a large number of patients admitted to the Intensive Care Unit (ICU) is that of acute life support, with many extraordinary interventions occurring in order to ensure Survival. Factors that have been identified as contributing to pressure ulcer development such as restricted mobility, chronic disease, advanced age, impaired sensory perception, altered tissue perfusion and malnutrition are extremely prevalent, if not the norm for many ICU patients. This is coupled with the fact that patients may be sedated and receiving muscle relaxants not permitting natural intrinsic movement in response to pressure.
Delayed admission may also be a significant issue; many ICU’s have high bed occupancy and patients are likely to have been unwell for hours, if not days before they are admitted. Some patients will have had major surgery which adds additional risk factors for pressure ulcer development such as; anesthesia, surgical trauma, hemodynamic instability and hypothermia.
What is the Magnitude of the Problem?
The challenges of preventing pressure injuries in ICU patients are well acknowledged within the published literature. Pressure ulcer prevalence rates in ICU have been reported to vary from 13.6% to 42.1% and incidence rates of 5.2% to 20%.