Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review
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Published on: March 9, 2019
Aditi D Rao1, Ave M Preston, Robyn Strauss
1Aditi D. Rao, PhD, RN, Hospital of the University of Pennsylvania, Philadelphia. Ave M. Preston, MSN, RN, CWOCN, Hospital of the University of Pennsylvania, Philadelphia. Robyn Strauss, ACNS-BC, RN, MSN, WCC, Hospital of the University of Pennsylvania, Philadelphia. Rebecca Stamm, MSN, RN, CCNS, WCC, CCRN, Hospital of the University of Pennsylvania, Philadelphia. Demetra C. Zalman, MSN, CCRN-CSC, CRNP, Hospital of the University of Pennsylvania, Philadelphia.
Insights
Cardiac surgery patients face high risks of pressure ulcers (PUs). Current prevention methods are insufficient, necessitating targeted strategies based on unique risk factors like prolonged surgery and vascular disease.
Area of Science:
- Critical Care Medicine
- Surgical Nursing
- Patient Safety
Background:
- Cardiac surgery patients exhibit a high incidence of pressure ulcers (PUs), reaching up to 29.5%.
- Existing literature on PU risk factors and prevention is extensive, yet lacks focus on the specific cardiac surgery population.
- This gap highlights a critical need for research tailored to this vulnerable patient group.
Purpose of the Study:
- To systematically review and identify risk factors associated with pressure ulcer development in critically ill adult cardiac surgery patients.
- To synthesize current evidence on PU etiology within this specific high-risk demographic.
Main Methods:
- A systematic literature search was conducted across MEDLINE, CINAHL, and Cochrane databases.
- Studies focusing on PU risk factors in critical care, surgical intensive care, or cardiac surgery populations were included.
- PU occurrence was used as the primary outcome variable for study selection.
Main Results:
- Twelve high-quality studies identified 30 potential PU risk factors.
- Intraoperative factors (e.g., cardiopulmonary bypass time, body temperature) remain underexplored.
- Specific risk factors for deep tissue injuries, a distinct PU category, require further investigation.
Conclusions:
- Standard PU prevention strategies appear inadequate for cardiac surgery patients due to the high incidence.
- Development and implementation of targeted prevention measures are crucial.
- Further research is urgently needed to identify and address unique risk factors, such as prolonged surgical pressure, vascular disease, and postoperative vasopressor use.
Background:
Cardiac surgery patients are among those most at risk for developing pressure ulcers (PUs), with a reported incidence as high as 29.5%. Although numerous studies documenting PU risk factors and prevention strategies exist, the availability of literature examining risk factors specific to the cardiac surgery population is limited.
Aim:
A systematic review was completed that aimed to identify the risk factors associated with PU development in critically ill, adult, cardiac surgery patients.
Methods:
The MEDLINE, CINAHL, and Cochrane databases were searched. Studies that focused on PU risk factors in critical care, surgical intensive care, or cardiac surgery populations and used PU occurrences as an outcome variable were included in the review.
Findings:
Twelve high-quality studies were retrieved and included in the review; they revealed 30 potential PU risk factors. Current evidence is limited in 2 important ways. First, the impact of intraoperative factors, such as cardiopulmonary bypass time or body temperature, appears to be underexplored. Second, a substantive discussion of the risk factors associated specifically with deep tissue injuries, a unique PU category, is absent.
Conclusion:
The relatively high PU incidence among cardiac surgery patients suggests that typical PU prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented. Completion of this task required identification of risk factors unique to this population. Specific risk factors likely to increase risk among cardiac surgery patients include prolonged exposure to pressure during long surgical procedures, vascular disease, and/or vasopressor use postoperatively. Additional research concerning risk factors specific to this population is urgently needed.
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