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A Retrospective Observational Analysis of Factors Determining the Formation of Pressure Ulcers in ICU Patients
Anna Woźniak1, Jarosław Janc2, Patrycja Leśnik3
1Department of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
Insights
Critically ill COVID-19 patients frequently develop pressure ulcers (PUs), especially those with severe illness, requiring vasopressors, and longer hospital stays. Early intervention for these factors can improve outcomes and reduce PU incidence.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Dermatology
Background:
- Critically ill COVID-19 patients face a high risk of pressure ulcers (PUs).
- The COVID-19 pandemic has influenced PU incidence, location, and hospital preparedness.
- Understanding PU risk factors is crucial for managing severe COVID-19 cases.
Purpose of the Study:
- Investigate clinical and demographic factors linked to PUs in critically ill COVID-19 patients.
- Compare outcomes between patients with and without PUs.
- Assess the impact of septic shock, prone positioning, and other interventions on PU development, hospitalization duration, and mortality.
Main Methods:
- Retrospective analysis of 160 adult ICU patients with confirmed COVID-19 requiring invasive ventilation.
- Data collected included demographics, septic shock, ECMO, prone positioning, colonization, survival, SAPS II scores, and vasopressor use.
- Univariate and multivariate logistic regression were used to identify PU predictors.
Main Results:
- Pressure ulcers (PUs) developed in 48.12% of patients.
- Septic shock was more common in the PU group (30.12% vs 16.88%).
- Patients with PUs had higher SAPS II scores (56.40), greater vasopressor use (p=0.015), and significantly longer hospital stays (mean=14.08 days).
Conclusions:
- Disease severity (SAPS II), vasopressor use, and prolonged hospitalization are independent risk factors for PUs in critically ill COVID-19 patients.
- Higher disease severity and longer hospital stays correlate with increased PU incidence.
- Targeted preventive strategies addressing these risk factors are essential for improving patient outcomes.
Background:
Critically ill COVID-19 patients are at heightened risk for pressure ulcers (PUs), with the pandemic altering both the frequency and location of PU development and challenging hospital preparedness. The study aimed to investigate clinical and demographic factors associated with PUs in critically ill COVID-19 patients, compared outcomes between those who did and did not develop PUs, and assessed the impact of septic shock, prone positioning, and other interventions on PU formation, prolonged hospitalization, and mortality.
Materials And Methods:
A retrospective analysis was conducted on 160 adults with lab-confirmed COVID-19 treated in the intensive care unit (ICU) of the 4th Military Clinical Hospital in Wroclaw (Poland) between September 2020 and September 2022. The criterion for inclusion in the study was confirmed COVID-19 disease and need for invasive ventilation. Demographic data, incidence of septic shock, use of the Extracorporeal Membrane Oxygenation (ECMO), prone positioning, colonization, survival rates, SAPS (Simplified Acute Physiology Score) II scores, and vasopressor (argipressin) requirements were recorded. Univariate and multivariate logistic regression identified significant predictors of PUs development.
Results:
PUs occurred in 48.12% (n=77) of patients. Septic shock was more prevalent among those with PUs (30.12% vs 16.88%, p=0.049). PUs group had higher mean SAPS II scores (56.40) and greater argipressin use (0.50 units, p=0.015). Length of stay was significantly longer for patients with PUs (mean=14.08 days, p<0.001). Multivariate analysis showed that higher SAPS II scores, argipressin use, and extended hospitalization were independent risk factors, while 28-day survival was protective against PUs formation.
Conclusion:
PUs development in critically ill COVID-19 patients is strongly linked to disease severity, vasopressor requirements, and prolonged hospitalization. Targeted preventive measures focusing on these risk factors could help mitigate PUs incidence and improve patient outcomes.
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