October 26, 2020

An article review from the ESICM Journal Review Club

First point-prevalence study to provide a global picture of the epidemiology of PIs in adult ICUs patients

Pressure injuries (PIs) in ICU settings have a negative impact on patient outcomes, whilst they constitute a burden for health care economics. Despite the above, robust research into PIs amongst ICU patients, at a worldwide level, has been under-prioritised [1].  As a result, the global epidemiology of PIs is lacking.

The DecubICUs study[2] by Labeau and her colleagues (2020) tackled the above problem by quantifying the international extent of PIs and by identifying the factors associated with ICU-acquired PIs in adult ICU patients.

The authors recruited 1,117 ICUs in 90 countries (6 continents). Data from 13,254 patients revealed an overall PIs prevalence of 26.6% (95% CI 25.9–27.3) with 18% (95% CI 17.3–18.6) of stage II or worse; ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8), with 11.0% (95% CI 10.5–11.5) of stage II or worse.

Low and lower-middle-income economies reported the highest overall prevalence (40.7%, 95% CI 36.7–44.8) of PIs and ICU-acquired PIs (27.7%, 95% CI 24.1–31.5). The most affected anatomical sites were the sacral region and heels.

Factors independently associated with ICU-acquired PIs were older age, male sex, being underweight, higher SAPS II score, low score (<19) in Braden scale (high risk for developing PIs), organ support by mechanical ventilation and renal replacement therapy.

Additionally, patients with LOS>12 days in ICU before the data collection date had a 7.5-fold increased risk of ICU-acquired PIs compared to those with a LOS ≤ 3 days. Gradually increasing associations with mortality were also identified for increasing severity of pressure injury.

STUDY STRENGTHS & LIMITATIONS

This is the first point-prevalence study that provides a global picture of the epidemiology of PIs in adult ICU patients using rigorous methods and protocols for the data collection. The cross-sectional design of the study might have resulted in bias in reported prevalence locally and geographically. However, the large sample size spread across six continents and the exploratory statistical approach strengthen the study’s findings on risk factors for ICU-acquired PIs and associated mortality.

TAKE HOME MESSAGE

The present study underscores that the ICU patient in contemporary ICUs has a high-risk profile for developing PIs, mainly due to intrinsic factors; and found ICU-acquired PIs to be associated with mortality. Considering the high incidence of PIs in ICU settings, their prevention should target a) intense clinical awareness, and b) efficient resource allocation.

This article review was prepared and submitted by Katerina Iliopoulou, King’s College London (KCL) Department of Adult Nursing, United Kingdom, on behalf of the ESICM N&AHP Committee.


REFERENCES
  1. Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, Nogueira PC, Lin FF. Incidence and prevalence of pressure injuries in adult intensive care patients: A systematic review and meta-analysis. Read Online: Critical Care Medicine| Society of Critical Care Medicine. 2018 Nov 1;46(11):e1074-81.
  2. Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, Calvino-Gunther S, Chaboyer W, Coyer F, Deschepper M, François G. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Medicine. 2020 Oct 9:1-0.

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