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Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU

Soodmand, Mostafa MSc; Moghadamnia, Mohammad Taghi PhD; Aghaei, Iraj PhD; Ghasemzadeh, Golshan BSN; Kazemnejad Lili, Ehsan PhD; Homaie Rad, Enayatollah PhD

doi: 10.1097/01.ASW.0000553599.20444.f4
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OBJECTIVE To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation.

METHODS This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. They collected demographic, hemodynamic, and oxygenation data until a pressure ulcer occurred, the patient’s artificial airway was removed, the patient died, or the patient was discharged.

RESULTS From August 2017 to February 2018, a total of 2,581 patients were admitted to the study ICUs; of these, 133 patients were eligible for the study. The results indicated that 41.4% (n = 55) of the patients ended up with pressure ulcers. Investigation of the variables using a Cox regression model showed that, among other variables considered in this study, age, mean arterial pressure, and positive end-expiratory pressure in the mechanical ventilator can contribute to the risk of pressure ulcers.

CONCLUSIONS Providers should pay attention to changes in hemodynamic parameters, especially mean arterial pressure; carefully determine the most appropriate positive end-expiratory pressure for patients connected to mechanical ventilation; and take special care of susceptible groups such as older adults and hospitalized patients to decrease the incidence of pressure ulcers.

At the Guilan University of Medical Sciences, in Rasht, Iran, Mostafa Soodmand, MSc, is a medical-surgical nursing student, School of Nursing and Midwifery; Mohammad Taghi Moghadamnia, PhD, is Assistant Professor of Health in Disasters and Emergencies, Department of Medical-Surgical Nursing, School of Nursing and Midwifery; Iraj Aghaei, PhD, is Assistant Professor of Neurosciences, Social Determinants of Health Research Center; Golshan Ghasemzadeh, BSN, is a researcher, Healthy Heart Research Center, Heshmat Hospital; Ehsan Kazemnejad Lili, PhD, is Associate Professor of Biostatistics, School of Nursing and Midwifery; and Enayatollah Homaie Rad, PhD, is Assistant Professor of Health Economics, Social Determinants of Health Research Center.

Acknowledgments: The authors thank the participants of the study.

This research project was financially supported by the Deputy of Research and Technology at the Guilan University of Medical Sciences.

Submitted June 23, 2018; accepted in revised form August 3, 2018.

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