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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

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Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the

Su Yeon Lee1, Dong Kyu Oh1, Sang-Bum Hong1

  • 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

The Korean Journal of Internal Medicine
|September 21, 2022
PubMed

Insights

Prolonged use of neuromuscular blocking agents and opioids increases pressure injury risk in ICU patients. Minimizing these medications and promoting early patient mobilization are key prevention strategies.

Area of Science:

  • Critical Care Medicine
  • Patient Safety
  • Nursing Research

Background:

  • Intensive care unit (ICU) patients face a high risk of developing pressure injuries.
  • Pressure injuries can lead to severe complications and increased mortality.
  • Effective prevention strategies are crucial for this vulnerable population.

Purpose of the Study:

  • To investigate the specific risk factors associated with pressure injury development in ICU patients.
  • To identify modifiable and non-modifiable factors contributing to pressure injury onset.

Main Methods:

  • Retrospective analysis of 666 adult patients admitted to a medical ICU from January to December 2019.
  • Data collection included patient demographics, medications, mechanical ventilation, hemodialysis, laboratory results, and pressure injury development.
  • Statistical analysis identified risk factors using odds ratios and p-values.

Main Results:

  • Pressure injuries developed in 15% (102 out of 666) of patients without pre-existing injuries.
  • Increased administration days of neuromuscular blocking agents (NMBAs) and opioids significantly elevated pressure injury risk.
  • Patients experiencing friction and shear had a substantially higher risk (OR, 2.203; p = 0.011).

Conclusions:

  • Prolonged use of NMBAs and opioids is linked to increased pressure injury development due to associated immobilization.
  • Minimizing the use of these medications and encouraging early patient mobilization are recommended.
  • The Braden scale subscale 'friction and shear' is a significant predictor of pressure injuries in the ICU setting.
Abstract

Keywords:
Analgesics, opioidImmobilizationIntensive care unitsNeuromuscular blocking agentsPressure injury

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