压力损伤患者接受体外膜氧合：三级中心经验。

IF 1.7 4区医学 Q3 DERMATOLOGY

Journal of wound care Pub Date : 2025-08-02 DOI:10.12968/jowc.2023.0218

Halide Oğuş, A Ece Altınay, Fatih Yiğit, Ayhan Güneş, Yeliz Karacı, Seda Karasakal, Merve Karanis Taştan, Ceyda Canbey Baydilli, Şirin Menekşe, Mehmet Kaan Kırali

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引用次数: 0

摘要

目的：压力损伤（PIs）在重症监护和体外膜氧合（ECMO）患者中很常见。本研究评估了covid -19相关急性呼吸窘迫综合征（ARDS） ECMO患者PIs的发生率及危险因素。方法：对2020年4月至2022年1月入住重症监护病房（ICU）并接受静脉-静脉ECMO治疗的重症covid -19相关ARDS患者进行评估。所有患者均按照《预防和治疗压疮：2019年临床实践指南》进行监测、评估和管理。采用Braden量表评估PI风险。根据国家压力损伤咨询委员会的指导方针进行pi分期。结果：78例患者（中位年龄45岁）接受了ICU护理和ECMO支持。其中，75例患者在ECMO支持下转至ICU；24/78（30.8%）患者已经有pi。24例患者（24/54,44.4%）在延长ECMO时间（中位48.5天）期间出现新的pi。新的pi主要出现在第二阶段（55%）。ECMO期间发生新PI的中位时间为21天（范围4-60天）。死亡率为32/54（59.3%）。在多变量分析中，年龄(优势比（OR）： 1.103, 95%可信区间（CI）： 1.022, 1.191；p=0.027)和ECMO持续时间(OR: 1.048, 95% CI: 1.016, 1.081；p=0.003)是PI发展的独立预测因子。结论：ICU专业团队严格遵守PIs临床实践指南可显著降低长期ECMO患者的PIs发生率。

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Pressure injuries in patients receiving extracorporeal membrane oxygenation: a tertiary centre experience.

Objective: Pressure injuries (PIs) are common in patients receiving intensive care and extracorporeal membrane oxygenation (ECMO). This study assessed the incidence and risk factors of PIs in patients receiving ECMO for COVID-19-associated acute respiratory distress syndrome (ARDS).

Method: Patients who were admitted to the intensive care unit (ICU) with severe COVID-19-associated ARDS and received veno-venous ECMO between April 2020 and January 2022 were evaluated. All patients were monitored, evaluated and managed according to the Prevention and treatment of pressure ulcers: clinical practice guideline 2019. The risk for PI was evaluated using the Braden scale. Staging of PIs was made according to the National Pressure Injury Advisory Panel guidelines.

Results: A total of 78 patients (median age 45 years) received ICU care and ECMO support. Of these, 75 patients were transferred to the ICU while on ECMO support; 24/78 (30.8%) patients already had PIs. New PIs developed in 24 patients (24/54, 44.4%) during prolonged periods of ECMO (median 48.5 days). The new PIs were mainly stage 2 (55%). The median time to new PI development during ECMO was 21 (range 4-60) days. The mortality rate was 32/54 (59.3%). In multivariable analysis, age (odds ratio (OR): 1.103, 95% confidence interval (CI): 1.022, 1.191; p=0.027) and ECMO duration (OR: 1.048, 95% CI: 1.016, 1.081; p=0.003) were independent predictors of PI development.

Conclusion: Strict compliance with the clinical practice guidelines for PIs by a dedicated ICU team may considerably reduce the incidence of PIs among patients receiving ECMO for prolonged periods.

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来源期刊

Journal of wound care DERMATOLOGY-

CiteScore

2.90

自引率

10.50%

发文量

215

期刊介绍： Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.