The Effect of Support Surfaces in the Incidence of Pressure Injuries in Critically Ill Patients: a Randomized Clinical Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 62
- 试验地点
- 2
- 主要终点
- class II pressure injury
研究概览
简要总结
The presence of pressure injuries has been considered a quality indicator of health care services and efforts has been made to develop guidelines to prevent this issue. Intensive care unit admissions (ICU) are recognized as risk factors to develop pressure injuries due to reduced mobility of critically ill patients and large number of devices and hard technologies that jeopardize preventive measures, such as, decubitus changes. There are not current definitive evidence about the superiority of any support surface to treat or prevent pressure injuries. The objective of the present study is to analyze if the use of viscoelastic support surface in vulnerable critically ill patients decreases the incidence of pressure injury compared with pyramidal foam support surface.
Randomized clinical trial performed in an intensive care unit for adult patients in a philanthropic hospital. Inclusion criteria are patients admitted to ICU with Braden scale ≤ 14. Exclusion criteria are age under 18 years, less than 24 hours of ICU length of stay, contraindication of performing complete institutional preventive measures for support injuries, presence of support injuries at ICU admission or absence of informed consent. Randomization will be made by computerized generated numbers and patients will be allocated in two groups in a ratio of 1:1. All study patients will be cared for according to standard institutional preventive measures. The interventional group will be placed in an ICU bed with viscoelastic support surface and the control group in an ICU bed with pyramidal foam support surface. The main outcome evaluated will be the occurrence of type II pressure injury. Secondary outcomes are the time to the occurrence of pressure injury, length of ICU and hospital stay and 28 days mortality rate. Significance level will be 5%.
详细描述
A randomized clinical trial with intent-to-treat analysis will be performed involving critical patients at high risk for development of pressure ulcers, that is; those presenting a Braden ≤ 14 scale at ICU admission in a one year period.
According to the Braden scale, six subscales or risk factors are validated: 1 - sensory perception, 2 - humidity, 3 - activity, 4 - mobility, 5 - nutrition and friction, and 6 - shearing. The total score varies from 6 to 23 points and patients are classified as: very high risk (scores less than or equal to nine), high risk (10 to 12 points), moderate risk (13 to 14 points), low risk (15 to 18 points), and without risk (19 to 23 points).
The exclusion criteria is aged less than 18 years, length of stay in the ICU less than 24 hours, contraindication for the performance of the standard PU prevention measures of the institution, presence of PU at ICU admission, and absence of the Informed Consent Term (ICT).
Randomization will be performed using a computerized table and patients will be allocated into two groups. Patients in the intervention group will be cared for according to the standard PU prevention measures of the institution and use a viscoelastic mattress as a bedding surface with the following characteristics: conventional density foam, density 40, and viscoelastic, density 60, polyurethane coated reinforced with 100% polyester mesh. Patients in the control group will be cared for according to standard PU prevention measures of the institution and use a pyramidal foam mattress as a support surface with a density of 33.
The institution's PU prevention measures are: apply body moisturizer after bathing without massaging bony prominences or areas with hyperemia; inspect the skin in the cephalo-caudal direction, especially the areas of bony prominences every 24 hours to observe hyperemias, dryness, heat, hardness, and maceration; rigorously evaluate whether the entire oral or enteral diet was ingested, taking into account the gastric residue and change in decubitus position every 2 hours; evaluate the need for application of dressings to protect bony protrusions from friction; always use the traction to mobilize the patient in the bed.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patients admitted to ICU with Braden scale ≤ 14
排除标准
- •age under 18 years
- •less than 24 hours of ICU length of stay
- •contraindication for performing complete institutional preventive measures for support injuries
- •presence of support injuries at ICU admission
- •absence of informed consent
研究组 & 干预措施
viscoelastic group
viscoelastic surface support
干预措施: viscoelastic surface support (Other)
pyramidal foam group
pyramidal foam surface support
干预措施: pyramidal foam surface support (Other)
结局指标
主要结局
class II pressure injury
时间窗: through study completion, an average of 30 days
Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present.
次要结局
- Time to develop pressure injury(through study completion, an average of 30 days)
- Length of ICU stay(through study completion, an average of 30 days)
- Length of hospital stay(through study completion, an average of 30 days)
- Mortality rate(28 days)
研究者
Cintia Magalhães Carvalho Grion
Professor adjunto
Universidade Estadual de Londrina