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The Relationship Among Pressure Ulcers, Oxygenation, and Perfusion in Mechanically Ventilated Patients in an Intensive Care Unit

Şenturan, Leman; Karabacak, Ükke; Özdilek, Sebahat; Alpar, Şule Ecevit; Bayrak, Songül; Yüceer, Songül; Yldz, Nebahatıı

Journal of Wound, Ostomy and Continence Nursing: September-October 2009 - Volume 36 - Issue 5 - p 503–508
doi: 10.1097/WON.0b013e3181b35e83
WOUND CARE
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PURPOSE We examined the relationships among oxygenation, tissue perfusion, and other comorbid conditions not incorporated into the Norton Scale, and pressure ulcer (PU) development in subjects receiving mechanical ventilation.

DESIGN Descriptive, observational study.

SETTING AND SUBJECTS The setting was our university hospital's surgical/emergency intensive care unit in Istanbul province, Turkey. The sample comprised 30 patients who were older than 18 years, did not have a PU on admission, and had been mechanically ventilated for more than 24 hours when data collection began.

METHODS Skin integrity and a PU risk, using the Norton Scale, were administered twice daily. In addition, serum blood testing, vital signs, and data regarding ventilation and oxygenation status were obtained from the patient's electronic medical records.

RESULTS Slightly less than half of subjects were women (n = 14, 46.7%). Their mean age was 54.36 years (SD = 20.68). Pressure ulcers developed in 5 patients (16.7%); all PUs were located on the heel. All ulcers were initially observed as stage I lesions; 1 progressed to a stage II ulcer and 1 progressed to a stage III ulcer. Patients who developed pressure ulcers have higher serum glucose levels (z = −2.198; P = .028), higher serum pH levels (z = −2.031; P = .028), and lower diastolic blood pressures (z = 0.055; P = .057) than those who remained ulcer free.

CONCLUSION Our results demonstrate that mechanically ventilated patients who develop PUs were more likely to have significantly higher blood glucose levels, significantly lower diastolic blood pressure values, and significantly higher serum pH values than were patients who remained free of PUs. Nurses who care for mechanically ventilated patients should recognize these factors and initiate preventive interventions as indicated.

Leman Şenturan, BSN, PhD, Assistant Professor, Haliç University School for Health Sciences, Istanbul, Turkey.

Ükke Karabacak, BSN, PhD, Assistant Professor, Department of Fundamentals of Nursing, Marmara University College of Nursing, Istanbul, Turkey.

Sebahat Özdilek, Critical Care Nurse, Emergency Surgery ICU, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Şule Ecevit Alpar, BSN, PhD, Associate Professor, Department of Fundamentals of Nursing, Marmara University College of Nursing, Istanbul, Turkey.

Songül Bayrak, Critical Care Nurse, Emergency Surgery ICU, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Songül Yüceer, Critical Care Nurse, Emergency Surgery ICU, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Nebahat Yıldız, Critical Care Nurse, Emergency Surgery ICU, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Corresponding author: Leman Şenturan, BSN, PhD, Haliç Üniversitesi Sağlık Bilimleri Yüksekokulu, Okçu Musa Cad. Emekyemez Mah. Mektep sk. No: 21 Şişhane, Istanbul, Turkey (lemansenturan@halic.edu.tr).

This study was presented as an oral presentation at the 6th National Congress of Trauma and Emergency Surgery, Antalya, Turkey, in 2007.

Copyright © 2009 by the Wound, Ostomy and Continence Nurses Society