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1.
Crit Care Res Pract. 2018 Dec 18;2018:3712067. doi: 10.1155/2018/3712067. eCollection 2018.

The Effect of Support Surfaces on the Incidence of Pressure Injuries in Critically Ill Patients: A Randomized Clinical Trial.

Author information

1
Post-graduate Student, Universidade Estadual de Londrina, Londrina, Brazil.
2
Registered Nurse, Universidade Estadual de Londrina, Londrina, Brazil.
3
Registered Nurse, Associação Evangélica Beneficente de Londrina, Londrina, Brazil.
4
Medicine Graduate Student, Unicesumar, Maringá, Brazil.
5
Professor, Department of Internal Medicine, Universidade Estadual de Londrina, Londrina, Brazil.

Abstract

Purpose:

To analyze whether a viscoelastic mattress support surface can reduce the incidence of stage 2 pressure injuries compared to a standard hospital mattress with pyramidal overlay in critically ill patients.

Method:

A randomized clinical trial with intention-to-treat analysis was carried out recruiting patients with Braden scale ≤14 on intensive care unit admission from April 2016 to April 2017. Patients were allocated into two groups: intervention group (viscoelastic mattress) and control group (standard mattress with pyramidal overlay). The level of significance adopted was 5%.

Results:

A total of 62 patients were included in the study. There was a predominance of males (53%) and the mean age was 67.9 (SD 18.8) years. There were no differences in clinical or severity characteristics between the patients in the control group and the intervention group. Pressure injuries occurred in 35 patients, with a median time of 7 days (ITQ 4-10) from admission. The frequency of pressure injuries was higher in the control group (80.6%) compared to the intervention group (32.2%; p < 0.001).

Conclusions:

Viscoelastic support surfaces reduced the incidence of pressure injuries in moderate or higher risk critically ill patients when compared to pyramidal support surfaces.

3.
Cureus. 2018 Oct 27;10(10):e3504. doi: 10.7759/cureus.3504.

A Case Review of Wound Bed Preparation in an Infected Venous Leg Ulcer Utilizing Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation.

Author information

1
Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA.
2
Plastic Surgery, Reading Hospital, Wyomissing, USA.

Abstract

Chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) have major financial implications for patients and healthcare professionals. VLUs, in particular, require significant care, can be slow to heal, and have a high rate of recurrence. These factors combine to make VLUs a major burden on the healthcare system. Recent estimates show that the cost of treatment of VLUs per patient in the United States is $10,000 to $12,000 per year, with the average lifetime cost of care greater than $40,000. Infected VLUs often require surgical debridement for the removal of bacterial burden and biofilm. The use of negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown to decrease OR visits, length of hospitalization, and therapy days in lower extremity and trunk wounds. In 2017, a novel reticulated open cell foam dressing with through holes (ROCF-CC) was introduced as a dressing option with NPWTi-d. ROCF-CC assists in removing thick wound exudate and infectious materials. This dressing option is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.

KEYWORDS:

instillation; negative pressure wound therapy; thick exudate; venous leg ulcer; wound bed preparation; wound cleansing

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

4.
Cureus. 2018 Oct 26;10(10):e3497. doi: 10.7759/cureus.3497.

A Case Review of Necrotizing Soft Tissue Infection of the Abdomen Utilizing Negative Pressure Wound Therapy with Instillation and Novel Reticulated Open Cell Foam Dressing.

Author information

1
Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA.

Abstract

Necrotizing soft tissue infection is a rapidly spreading bacterial infection that can quickly destroy a person's muscles, skin, and underlying tissue. In this retrospect chart review, we will look at how the utilization of negative pressure wound therapy with instillation and dwell (NPWTi-d) and novel reticulated open cell foam (ROCF-CC) assisted with the healing of a patient's wound along with decreasing the time spent in the operating room. NPWTi-d provided the benefits of wound healing such as solubilizing the infectious material and removing the devitalized tissue. Using this form of treatment, we were able to improve the patient's quality of life and decrease her time in the hospital.

KEYWORDS:

instillation; necrotizing soft tissue infection; negative pressure wound; wound care; wound cleansing

Conflict of interest statement

Kersten Reider and Elizabeth McElroy are both speakers and consultants for Acelity.

5.
Cureus. 2018 Oct 23;10(10):e3483. doi: 10.7759/cureus.3483.

Utilizing Negative Pressure Wound Therapy with Instillation and Dwell Time for Extensive Necrotizing Fasciitis of the Lower Extremity: A Case Report.

Author information

1
Orthopedic Surgery, Queen's Medical Center, Honolulu, USA.
2
Orthopedic Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, USA.

Abstract

Necrotizing fasciitis is a rapidly spreading infection of the soft tissue, which carries significant morbidity and mortality. This condition is treated with broad-spectrum antibiotics, irrigation and surgical debridement of the affected area, and hemodynamic support. Negative pressure wound therapy (NPWT) has been utilized after surgical debridement to promote wound healing, especially when significant debridement has occurred. Newer forms of NPWT such as negative pressure wound therapy with instillation and dwell time (NPWTi-d) have shown even greater promise by reducing the time to clear infections and promoting greater debridement with fewer procedures. This case report demonstrates the successful use of NPWTi-d on a 56-year-old man with a severe case of necrotizing fasciitis of the right lower extremity after extensive debridement. Despite the significant loss of soft tissue and the circumferential devitalization of the lower leg, this patient was able to accept a skin graft in approximately four weeks after admission to the hospital. Three months after initial presentation, his wounds were completely epithelialized and healing well. The advantages of using NPWTi-d include decreased dressing changes, increased wound granulation, and faster infection clearance. The disadvantages of such systems include increased cost, additional technical requirements, and required inpatient monitoring of the system. Despite these disadvantages, the authors believe that NPWTi-d is a reasonable choice for patients similar to the one presented in this case report.

KEYWORDS:

dwell; extremity; fasciitis; infection; instillation; necrotizing; negative; pressure; therapy; wound

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

6.
J Wound Ostomy Continence Nurs. 2019 Jan/Feb;46(1):13-17. doi: 10.1097/WON.0000000000000497.

Alternating Pressure Overlay for Prevention of Intraoperative Pressure Injury.

Author information

1
Jain Joseph, MD, Plastic and Reconstructive Surgery, Summit Medical Group, Berkeley Heights, New Jersey. Dylan McLaughlin, MS, Wayne State University, School of Medicine, Detroit, Michigan. Vigen Darian, MD, Division of Plastic and Reconstructive Surgery, Henry Ford Hospital, Detroit, Michigan. Lillian Hayes, BS, Division of Surgical Research, Henry Ford Hospital, Detroit, Michigan. Aamir Siddiqui, MD, Division of Plastic and Reconstructive Surgery, Henry Ford Hospital, Detroit, Michigan.

Abstract

PURPOSE:

The purpose of this study was to evaluate the effect of a low-profile alternating pressure (AP) overlay system on hospital-acquired pressure injuries (HAPIs).

DESIGN:

Prospective case series with historical controls.

SUBJECTS AND SETTING:

The study setting was the operating room and critical care unit of an urban quaternary care hospital in the Midwestern United States. One hundred neurosurgery patients undergoing surgery for 2 hours or longer in supine position were included in the study (AP group). The outcomes for the AP group were compared to a historical control group of 292 patients.

METHODS:

A group of 100 patients were prospectively placed on the AP overlay during surgery. Participants were enrolled preoperatively and tracked by the research team during their hospital stay. Demographic data, details of the operation, and pressure injury risk factors were recorded. Following surgery, AP group patients were evaluated daily and continued on standard protocol for pressure injury prevention. The primary study outcome was HAPI rate during the perioperative period (up to 5 days postsurgery) for the AP group (plus standard of care) compared to the standard of care alone (historical control). Control group data were extracted from electronic health records for the prior 2 years. A written questionnaire was given to the care team that used the AP technology; items queried the degree of acceptance of the overlay by surgeons and the operating room and intensive care unit (ICU) staff.

RESULTS:

None of the patients in the AP group developed perioperative pressure injuries. Review of historical control group revealed a 6% perioperative pressure injury incidence (18 pressure injuries in a group of 292 patients). Responses on the written questionnaire indicated that the AP technology was well accepted by surgeons and the operating room and ICU staff. There were no adverse events.

CONCLUSIONS:

Study findings suggest that AP overlay system can safely and reliably be used during neurological surgeries. Findings further suggest that using the AP product may improve outcomes with respect to perioperative HAPIs, including patients deemed at high risk for pressure injury development. Further studies are underway to evaluate the use of this AP overlay system beyond the operating room for more comprehensive care.

7.
Clin Nurs Res. 2019 Jan 2:1054773818817696. doi: 10.1177/1054773818817696. [Epub ahead of print]

Effect of Pressure Injury Prevention Guides Used In a Pediatric Intensive Care.

Author information

1
1 Okan University, Istanbul, Turkey.
2
2 Istanbul University, Turkey.

Abstract

The aim of this study was to determine the effectiveness of a pressure injury prevention guide used in a pediatric intensive care unit (PICU) on the occurrence of pressure injuries. The design is a pre-post intervention with a control group and a prospective intervention group. Pressure injuries occurred on 9.4% of children in the nontreatment group, and in 3.6% of children in the treatment group. There was a statistically significant difference in the occurrence of pressure injuries between the nontreatment group and the treatment group ( p = .033). The average Braden Q pressure injury score was 12.20 ± 2.280 at the beginning of the intensive care hospitalization, and 13.73 ± 3.312 at discharge in the treatment group ( p < .001). The results show that the risk of pressure injuries was reduced and pressure injuries occurred later when an evidence-based pressure injury prevention guide was used.

KEYWORDS:

guidelines; pediatric intensive care; pediatric nursing; pressure injury

8.
Health Technol Assess. 2018 Dec;22(73):1-162. doi: 10.3310/hta22730.

Negative-pressure wound therapy versus standard dressings for adults with an open lower limb fracture: the WOLLF RCT.

Author information

1
Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
2
University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
3
Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
4
Selly Oak Hospital, Birmingham, UK.

Abstract

BACKGROUND:

Open fractures of the lower limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-fracture wound.

OBJECTIVES:

To assess the disability, rate of deep infection, quality of life and resource use in patients with severe open fracture of the lower limb treated with negative-pressure wound therapy (NPWT) versus standard wound management after the first surgical debridement of the wound.

DESIGN:

A pragmatic, multicentre randomised controlled trial.

SETTING:

Twenty-four specialist trauma hospitals in the UK Major Trauma Network.

PARTICIPANTS:

A total of 460 patients aged ≥ 16 years with a severe open fracture of the lower limb were recruited from July 2012 through to December 2015. Patients were excluded if they presented more than 72 hours after their injury or were unable to complete questionnaires.

INTERVENTIONS:

Negative-pressure wound therapy (n = 226) where an 'open-cell' solid foam or gauze was placed over the surface of the wound and connected to a suction pump which created a partial vacuum over the dressing versus standard dressings not involving negative pressure (n = 234).

MAIN OUTCOME MEASURES:

Disability Rating Index (DRI) - a score of 0 (no disability) to 100 (completely disabled) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. The secondary outcomes were deep infection, quality of life and resource use collected at 3, 6, 9 and 12 months post randomisaton.

RESULTS:

There was no evidence of a difference in the patients' DRI at 12 months. The mean DRI in the NPWT group was 45.5 points [standard deviation (SD) 28.0 points] versus 42.4 points (SD 24.2 points) in the standard dressing group, giving a difference of -3.9 points (95% confidence interval -8.9 to 1.2 points) in favour of standard dressings (p = 0.132). There was no difference in HRQoL and no difference in the number of surgical site infections or other complications at any point in the 12 months after surgery. NPWT did not reduce the cost of treatment and it was associated with a low probability of cost-effectiveness.

LIMITATIONS:

Owing to the emergency nature of the interventions, we anticipated that some patients who were randomised into the trial would subsequently be unable or unwilling to take part. Such post-randomisation withdrawal of patients could have posed a risk to the external validity of the trial. However, the great majority of these patients (85%) were found to be ineligible after randomisation. Therefore, we can be confident that the patients who took part were representative of the population with severe open fractures of the lower limb.

CONCLUSIONS:

Contrary to the existing literature and current clinical guidelines, NPWT dressings do not provide a clinical or an economic benefit for patients with an open fracture of the lower limb.

FUTURE WORK:

Future work should investigate alternative strategies to reduce the incidence of infection and improve outcomes for patients with an open fracture of the lower limb. Two specific areas of potentially great benefit are (1) the use of topical antibiotic preparations in the open-fracture wound and (2) the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture.

TRIAL REGISTRATION:

Current Controlled Trials ISRCTN33756652 and UKCRN Portfolio ID 11783.

FUNDING:

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 73. See the NIHR Journals Library website for further project information.

PMID:
30573002
PMCID:
PMC6322061
DOI:
10.3310/hta22730
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Conflict of interest statement

Matthew L Costa is a member of the general board for the Health Technology Funding stream. Keith Willett received royalty payments from Zimmer for implant design outside the submitted work. Sarah E Lamb is a member of the Health Technology Assessment (HTA) Additional Capacity Funding Board, HTA End of Life Care and Add-on Studies, HTA Prioritisation Group and HTA Trauma Board.

9.
Ann Med Surg (Lond). 2018 Oct 10;36:246-251. doi: 10.1016/j.amsu.2018.10.007. eCollection 2018 Dec.

Negative Pressure Wound Therapy with Instillation in the Septic Open Abdomen Utilizing a Modified Negative Pressure Therapy System.

Author information

1
Universidad Federada San Judas Tadeo, San Jose, Costa Rica.
2
Christus Trinity Mother Frances Health System, Tyler, Texas, USA.

Abstract

Background:

Various treatment modalities are utilized to treat the open abdomen. The use of negative pressure wound therapy(NPWT)has been a great advancement and has become the preferred modality for temporary abdominal closure technique (TAC). Programmed instillation of the abdominal cavity with saline solution in conjunction with a commercial negative pressure system showed positive results in the management of severe abdominal sepsis in patients that were treated with an open abdomen. Severe abdominal sepsis continues to be an oftendifficult clinical problem for the general surgeon. The use of an open abdomen technique in this setting and the ideal TAC method continue to be debated. The failure to understand the biomechanical features/limitations of negative pressure devices are often contributing factors associated with therapeutic failures reported in the literature.

Objectives:

To describe the underlying principles behind negative pressure wound therapy with instillation in the context of abdominal sepsis, as well as its optimal usage in these conditions.

Methods:

A systematic review and two retrospective cohort studies, both published and unpublished performed by some of the authors were included to provide a basis form comparison between NPWT and NPWT-I outcomes in managing abdominal sepsis.

Conclusion:

Our findings suggest that this technique appears to reduce morbidity, mortality, and hospital and critical care length of stay. This communication is intended to help inform general surgeons that manage complex abdominal infections on how to optimally apply this technique.

KEYWORDS:

NPWT-i; Negative pressure wound therapy; Open abdomen. Sepsis; instillation therapy

Publication type

Publication type

10.
Neonatal Netw. 2018 Sep;37(5):319-323. doi: 10.1891/0730-0832.37.5.319.

Adopting Braden Q in the NICU to Identify Neonates at Risk of Developing Pressure Injuries.

Abstract

There are numerous factors placing neonates at increased risk of developing pressure injuries while hospitalized. Prevention of hospital-acquired pressure injuries in this vulnerable patient population requires early risk identification. Unfortunately, identifying neonates who are at risk of developing pressure injuries is complicated because of the lack of pressure injury risk assessment tools validated for use in neonates. The Braden Q risk assessment scale was adopted by two NICUs within a health care system to aid in identifying neonates at risk of developing a pressure injury. Additionally, the electronic health record was adapted to assist nurses in implementation of appropriate interventions to prevent pressure injuries based on Braden Q subscores.

KEYWORDS:

Braden Q; neonatal pressure injury; pressure injury risk assessment; skin injury

11.
Cureus. 2018 Sep 27;10(9):e3377. doi: 10.7759/cureus.3377.

Mechanisms of Action of Instillation and Dwell Negative Pressure Wound Therapy with Case Reports of Clinical Applications.

Author information

1
Plastic Surgery, Brigham and Women's Hospital, Boston, USA.
2
Plastic Surgery, Boston University School of Medicine, Boston, USA.
3
Plastic Surgery, Brigham & Women's Hospital, Boston, USA.

Abstract

Negative pressure wound therapy (NPWT) has revolutionized the care of complex wounds since 1997. The addition of instillation (NPWTi-d) adds several potential benefits and challenges to clinicians dealing with complex wounds in a hospital setting. We surveyed the literature regarding the mechanism of action of these devices and reviewed our clinical experience to date. Potential mechanisms of action include the removal of microorganisms from the wound surface, dilution of cytotoxic molecules, upregulation of angiogenesis pathways, and maintenance of a moist wound environment. As we have extended our use of these devices to more complex wounds, we have taken advantage of and observed potential mechanisms of action, including facilitated removal of microorganisms, dilution of inflammatory and cytotoxic macromolecules, additional wound hydration, and enhanced angiogenesis through an intermittent application of NPWT. We have also observed complications, including bleeding, loss of a seal along the wound, and pain. NPWTi-d provides additional options for clinicians caring for complex wounds with favorable responses in wounds with significant contamination and those with poor inherent vascularity. Further studies to clarify the mechanisms of action, better define the wound types that would benefit, and techniques to manage complications using this device should further advance this field.

KEYWORDS:

instillation vac; mechanism of action; negative pressure wound therapy; wound complications; wound healing; wounds

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

12.
AACN Adv Crit Care. 2018 Winter;29(4):426-431. doi: 10.4037/aacnacc2018426.

Reducing Tracheostomy-Related Pressure Injuries.

Author information

1
Lois M. Dixon is Wound Ostomy Continence Clinical Leader, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718 (lodixon@christianacare.org). Susan Mascioli is Director, Nursing Quality and Safety, Christiana Care Health System, Newark, Delaware. Jefferson H. Mixel is Clinical Manager, Department of Respiratory Care, Christiana Care Health System, Newark, Delaware. Tom Gillin is Critical Care Coordinator, Department of Respiratory Care, Christiana Care Health System, Newark, Delaware. Camille N. Upchurch is Physician, Christiana Care Hospitalist Partners, Christiana Care Health System, Newark, Delaware. Kevin M. Bradley is Medical Director of the Trauma Program, Christiana Care Health System, Newark, Delaware.

Abstract

An interprofessional team was established to prevent tracheostomy-related acquired pressure injuries. The team performed an in-depth analysis of practice from tracheostomy insertion through postinsertion care. A literature evaluation identified best practices, and a root cause analysis for all tracheostomy-related pressure injury cases identified common causes. Lessons learned from the practice and literature reviews drove care standardization and reduced variation. Preimplementation and postimplementation data were analyzed to determine the effectiveness of improvement interventions. Improvement strategies included use of a more flexible tracheostomy tube, standardization of suturing, timing of suture removal, application of a hydrocolloid dressing at time of insertion and a foam dressing after suture removal, and caregiver education regarding early identification of and interventions for complications related to sutures and swelling. The result has been an 80% reduction of tracheostomy-related acquired pressure injuries systemwide.

KEYWORDS:

hospital-acquired injury; quality improvement; tracheostomy; tracheotomy

13.
J Spinal Cord Med. 2018 Dec 12:1-10. doi: 10.1080/10790268.2018.1543094. [Epub ahead of print]

Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland.

Author information

1
a Department of Health Sciences and Health Policy , University of Lucerne and Swiss Paraplegic Research , Lucerne/Nottwil , Switzerland.
2
b Swiss Paraplegic Research , Nottwil , Switzerland.
3
c Swiss Paraplegic Centre , Nottwil , Switzerland.
4
d Swiss Paraplegic Association , Nottwil , Switzerland.

Abstract

CONTEXT:

Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.

DESIGN:

Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.

SETTING:

Switzerland.

PARTICIPANTS:

The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.

INTERVENTIONS:

Not applicable.

OUTCOME MEASURES:

Not applicable.

RESULTS:

Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.

CONCLUSION:

By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.

KEYWORDS:

Bedsores; Complications; Facilitators; Self-management; Semi-structured interviews; Thematic analysis

PMID:
30540555
DOI:
10.1080/10790268.2018.1543094
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14.
Plast Reconstr Surg Glob Open. 2018 Oct 3;6(10):e1953. doi: 10.1097/GOX.0000000000001953. eCollection 2018 Oct.

Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl.

Author information

1
Department of Pediatric Surgery, Meyer Children Hospital, Florence, Italy.
2
Pediatric Burn Center, Meyer Children Hospital, Florence, Italy.

Abstract

Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.

15.
Crit Care Nurs Q. 2019 Jan/Mar;42(1):117-126. doi: 10.1097/CNQ.0000000000000245.

Prevention of Pressure Injury by Using Silicone Foam Dressings: Experience at a University Hospital in Hong Kong.

Author information

1
Departments of Surgery (Ms Lee), Adult Intensive Care Unit (Messrs Lai and Chan), Neurosurgery (Ms Boo), Cardiothoracic Surgery (Ms Hui), and Orthopedic & Traumatology (Mr Kwong), Queen Mary Hospital, Pok Fu Lam, Hong Kong; and Department of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong (Ms Wan).

Abstract

Pressure injury is a serious problem and is common in critical care units. Over the last decade, there is new evidence suggesting that the use of multilayered silicone foam dressing as preventive measures can decrease the incidence and prevalence rate of hospital-acquired pressure injury. The purpose of this study was to investigate the clinical efficacy of this dressing in reducing sacral and coccygeal pressure injury incidence rate as compared with standard preventive interventions in critical care settings.

16.
Ostomy Wound Manage. 2018 Dec;64(12):38-48.

A Descriptive, Qualitative Study to Explore the Pain Experience During Negative Pressure Wound Therapy for Postsurgical Abdominal Wounds.

Author information

1
Faculty of Health Sciences, Department of Surgical Nursing, Trakya University, Edime, Turkey.
2
School of Health, Department of Nursing, Trakya University, Edime, Turkey.
3
Trakya University, Edime, Turkey.

Abstract

Pain during negative pressure wound therapy (NPWT) has been reported in the literature.

PURPOSE:

The study was conducted to describe patients' pain experience, pain-coping skills, and the effect of NPWT-related pain on daily life activities following abdominal surgery.

METHOD:

Using a descriptive, qualitative design, semi-structured face-to-face interviews were conducted between April 3, 2016 and December 26, 2016, in the surgical ward of a university hospital in Edirne, Turkey. Patients aged ≥18, receiving NPWT, who had at least 1 dressing change, and with no diagnosis of diabetes mellitus or neurological disease were included. Interviews were conducted at the patients' bedside 1 day after wound debridement. All wounds were covered with the NPWT black foam dressing, and NPWT settings were -50 mm Hg to -125 mm Hg. One (1) researcher led the interviews using a voice-recorder while 2 researchers observed and took notes. Data were analyzed using Colaizzi's phenomenological method.

RESULTS:

The themes identified were: 1) pain experience, 2) pain coping, 3) pain prevention, and 4) affects daily life activity. Patients mostly reported pain during foam dressing changes and wrap removal unless the dressing change occurred while receiving anesthesia. Self-applied pain-coping strategies between dressing changes included limiting mobility, trying not to cough, applying pressure, or walking; these strategies were mostly ineffective. The results are supported by many findings from other studies investigating the effects of NPWT on patient pain.

CONCLUSION:

This study provides further insight into the patients' wound pain experiences during NPWT and its effect on daily activities. Increased awareness about NPWT-associated pain and pain control measures as well as qualitative and controlled quantitative studies are needed. Inservice training and educational meetings should be conducted at surgical clinics to expand surgical nurse and physician knowledge and awareness of how to efficiently manage pain during NPWT treatment and related procedures.

PMID:
30516480
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17.
Wounds. 2018 Nov 22. pii: WNDS20181122-2. [Epub ahead of print]

Use of Negative Pressure Wound Therapy With Instillation and a Novel Reticulated Open-cell Foam Dressing With Through Holes at a Level 2 Trauma Center.

Author information

1
Integumetrix, Nashville, TN.

Abstract

INTRODUCTION:

Current wound treatment options for complex wounds include advanced wound therapies. One such treatment, negative pressure wound therapy (NPWT), has evolved to include automated instillation of topical wound solutions with a user-specified dwell time (NPWTi-d). A novel reticulated open-cell foam dressing with through holes (ROCF-CC) was developed to assist wound cleansing by removing thick wound exudate and infectious material.

OBJECTIVE:

The author's experience using NPWTi-d with ROCF-CC on complex wounds is presented.

MATERIALS AND METHODS:

Patients (N = 19) received antibiotics, pain medication (oral or intravenous), and debridement when applicable. The ROCF-CC contact layer with through holes was cut to fit the wound dimensions and placed in the wound bed. The cover layer (without holes) was placed over the contact layer to fill the remainder of the wound bed, including undermined areas. The foam layers were covered with a semi-occlusive drape, and NPWTi-d was initiated by instilling saline or a hypochlorous solution with a 1-minute to 10-minute dwell time followed by 2 to 3.5 hours of negative pressure (-125 mm Hg or -150 mm Hg). Dressing changes were performed every 2 to 3 days.

RESULTS:

Mean patient age was 57.1 ± 18.1 years. Common comorbidities included diabetes, obesity, and tobacco use. After an average of 9.0 ± 6.9 days of therapy, all wounds displayed less malodor, less devitalized tissue, and improved granulation tissue formation.

CONCLUSIONS:

In all 19 cases, adjunctive use of NPWTi-d with ROCF-CC contributed to hospital discharge, wound closure, and successful limb salvage in this patient population.

PMID:
30485170
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18.
Cureus. 2018 Sep 17;10(9):e3319. doi: 10.7759/cureus.3319.

Negative Pressure Wound Therapy with Instillation and Dwell Time in the Surgical Management of Severe Hidradenitis Suppurativa.

Author information

1
Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, USA.
2
Surgery, University of Maryland School of Medicine, Baltimore, USA.
3
Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore , USA.

Abstract

BACKGROUND:

Hidradenitis suppurativa (HS) is a physically debilitating disease that greatly impairs the quality of life of affected individuals. Advanced disease is often difficult to treat with topical and systemic therapies. Surgical resection of diseased skin has become paramount in HS management but proposes challenges of wound care and closure.

METHODS:

Four patients with a total of 12 complex wounds were treated over a three year period. All of the patients were males between the ages of 28 and 61 years. The lesions were located on the buttocks (n=5), chest (n=1), perianal (n=2), perineal (n=2), and axillary regions (n=2). A protocol of wide local excision, followed by negative pressure wound therapy with instillation and dwell time (NPWTi-d) to decrease bioburden and promote angiogenesis of the exposed base, and subsequent skin grafting was used. Patients remained hospitalized between procedures.

RESULTS:

The original wound area ranged from 210-540 cm2. Skin grafts of comparable sizes were taken from donor sites. The average duration of NPWTi-d placement was 3.5 days and the average time from excision to wound coverage was 4.3 days. The percent of graft uptake ranged from 70%-90%. All patients were resolved of their local disease with no complications.

CONCLUSIONS:

Surgical management of HS can be complicated by difficult closures. This case series demonstrates that wide local excision followed by NPWTi-d and skin grafting is able to achieve local resolution of disease in HS patients who have failed multiple minimally invasive therapies.

KEYWORDS:

hidradenitis suppurativa; negative pressure wound therapy with instillation and dwell; npwti-d; skin grafting; wound healing

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

19.
Aust Crit Care. 2018 Nov 20. pii: S1036-7314(18)30098-5. doi: 10.1016/j.aucc.2018.10.002. [Epub ahead of print]

Prevalence of pressure injury in adults presenting to the emergency department by ambulance.

Author information

1
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: paul.fulbrook@acu.edu.au.
2
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia. Electronic address: sandra.miles@acu.edu.au.
3
School of Nursing, Queensland University of Technology, Brisbane, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK. Electronic address: f.coyer@qut.edu.au.

Abstract

INTRODUCTION:

Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED).

METHODS:

An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation.

RESULTS:

Pressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk.

CONCLUSIONS:

The results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended.

KEYWORDS:

Emergency care; Emergency department; Pressure injury; Pressure injury prevention; Prevalence; Risk assessment

PMID:
30470644
DOI:
10.1016/j.aucc.2018.10.002
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20.
J Adv Nurs. 2018 Nov 20. doi: 10.1111/jan.13913. [Epub ahead of print]

The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults.

Author information

1
Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, Florida.
2
Department of Biobehavioral Nursing, College of Nursing, University of Florida, Gainesville, Florida.
3
Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida.

Abstract

AIMS:

To examine the effect of psychological distress in mediating the relationship between the severity of pressure injury and pain intensity in hospitalized adults.

BACKGROUND:

Despite the prevalence of pressure injury (previously known as pressure ulcers) in hospitalized adults, the current knowledge of pain associated with pressure injury is limited and findings are inconsistent. There is also a lack of understanding of the relationship between psychological distress and pain from pressure injury.

DESIGN:

Retrospective cross-sectional secondary analysis of data from electronic health records.

METHODS:

The data were retrieved from the third day of admission in the period between 2013 - 2016 through the Integrated Data Repository (IDR). Electronic health records were reviewed to collect data as needed. The mediation effect was tested by using path analysis implemented through Mplus.

RESULTS:

Path analysis revealed that the severity of pressure injuries and psychological distress have significant direct effects on pain intensity in hospitalized adults. However, the relationship between the severity of pressure injury and pain intensity was not significantly mediated by psychological distress.

CONCLUSION:

Hospitalized adults who have more severe pressure injury and more treatments for psychological distress experienced greater pain intensity. Healthcare providers must pay attention to treating psychological distress among hospitalized adults to manage pain. Further study is needed to validate these findings and it should incorporate more appropriate measures of psychological distress. The lack of standardized nursing documentation in electronic health records severely limits the usefulness of data from electronic health records for nursing research.

KEYWORDS:

electronic health records; hospitalized adults; nursing research; pain intensity; pressure injury; psychological distress; secondary analysis

PMID:
30456856
DOI:
10.1111/jan.13913
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