Incidence of pressure injuries in sacral and heels regions of critically ill patients maintained on a continuous low-pressure mattress.

Description

criteria: 18 years old or older; and presenting a Braden score ≤16. Those with a previous history of PI in the sacral or calcaneal regions, with cutaneous manifestations such as dermatitis associated with humidity, allergic reactions, urticaria, cellulitis, or other similar conditions in areas of bony prominence were excluded; in palliative care related to life support measures; pregnant women; receiving other interventions for the prevention of PI, which were not included in the institution's standard protocol; Total immobilization or with prescription of prone positioning. The researchers developed A daily follow-up instrument to collect demographic and clinical data, including skin inspection. Subepidermal skin moisture (SEM) measurements were taken at bony prominences of the sacrum and heels using the SEM SCANNER Provizio® equipment; the same regions were photographed using the C5 FLIR® infrared camera for thermographic analysis. Quantitative data were analyzed using descriptive statistics and presented using means, medians, and scales (standard deviation and interquartile range). For longitudinal variables, the Cox logistic regression model was used. Results: The sample consisted of 91 patients, with a mean age of 62.26 years (SD=13.78). The incidence of PI was 9.89%, with an average time of six days for its development. The sacral region was affected in 77.78% of the cases, 55.52% in stage 2. Diabetes Mellitus (DM) increased the risk of developing PI by 3.9 times (p=0.04), as well as Hypertension Systemic Arterial, which raised it by 7.84 times (p=0.05); blood glucose has been shown to increase the risk by 13 times (p=0.04) and, for every ten additional units, it increased the risk by 14.19 times. The inflammatory marker CRP also showed evidence of an association with the risk of developing PI: each increased CRP unit increases the risk by 5.8 times (p=0.053). The difference between the temperature of the central and peripheral regions of the bony prominence revealed a 22-fold increase in risk (p=0.012). This difference predicted the risk of developing PI three days before its onset (p=0.033). The delta measurement remained high in most of the sample, and there was no statistical relationship between subepidermal moisture and the development of PI. Conclusion: The relatively low incidence of 9.89% of pressure injuries (PU) compared to international studies suggests a positive impact of preventive measures, such as using a continuous low-pressure mattress. The association identified between Diabetes Mellitus, Systemic Arterial Hypertension, high blood glucose levels and the inflammatory marker CRP with
the risk of developing PI emphasizes the importance of personalized approaches for patients with these conditions. Thermography has emerged as a valuable risk indicator capable of predicting PI development. New studies with more extensive and diversified samples are necessary, mainly for establishing relationships between SEM and skin temperature, as assessed by thermography, and the early detection of PI.

Period	3 Oct 2023
Held at	Universidade de São Paulo, Brazil