Original Article

Associated factors of facial pressure ulcers in patients under non-invasive ventilation during hospital stay in an intermediate care facilities of a Portuguese hospital

Abstract

Background & Aim: Non-invasive ventilation is a procedure that reduces respiratory stress and improves gas exchange, using a patient-ventilator interface; however, it presents consequences such as the development of facial pressure ulcers. We aim to identify the factors associated with facial pressure ulcers in Intermediate Care Facilities patients submitted to non-invasive ventilation.
Materials & Methods: A cross-sectional descriptive and analytic study was performed in an intermediate care facilities, of a Portuguese hospital, from August to October of 2018, the study population consisted of patients hospitalized in this unit, who underwent to non-invasive ventilation. Data were collected through an observational form developed to obtain the information of the entire period of hospitalization of the patient. The software used to analyze the data was IBM SPSS Statistics for Windows, Version 23.0. For the descriptive analysis, absolute and relative frequencies also means and standard deviations were computed. Also, to describe the association between the variables, The point biserial correlation coefficient (rpb) were calculated. For data analysis, a significance level of .05 (α) was used.
Results: 14.6% of the individuals developed PU, all in the nasal pyramid. NIV was used for 6.07±3.91 days, and PU developed between the 3rd and the 20th day. It was observed that the presence of PU had a significant positive correlation with the GCS score (rpb=0.390, p=0.012) and a significant negative correlation with the duration of NIV (rpb=-0.438, p=0.004). Dependency level, PU risk, and nutritional risk did not correlate with the development of PU.
Conclusion: The pressure ulcers associated with non-invasive ventilation appear to be more frequently developed on the nasal pyramid and between the 3rd and the 20th day. Moreover, the level of consciousness and the time of administration of non-invasive ventilation are associated with the development of pressure ulcers.

1. Diez T, Fernandes A, Bibiana R, Fernandes C, Luís F, Oliveira L, et al. Face ulcer prevention in people undergoing Noninvasive Ventilation, sensitive indicators for the nursing care: A systematic review of the literature. Journal of Aging & Inovation. 2015;4(3):54–66.
2. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. European Respiratory Journal. 2017 Aug 1;50(2):1602426.
3. Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V, Raymondos K, Rios F, Nin N, Apezteguía C, Violi DA. Evolution of mortality over time in patients receiving mechanical ventilation. American journal of respiratory and critical care medicine. 2013 Jul 15;188(2):220-30.
4. Sferrazza GF, Marco F di, Akoumianaki E, Brochard L. Recent advances in interfaces for non-invasive ventilation: From bench studies to practical issues. Minerva Anestesiol. 2012;78(10):1146–53.
5. Papa GS, Di Marco F, Akoumianaki E, Brochard L. Recent advances in interfaces for non-invasive ventilation: from bench studies to practical issues. Minerva Anestesiol. 2012 Oct 1;78(10):1146-53.
6. Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. International journal of chronic obstructive pulmonary disease. 2014;9(9685):837–52.
7. Carron M, Freo U, BaHammam AS, Dellweg D, Guarracino F, Cosentini R, Feltracco P, Vianello A, Ori C, Esquinas A. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. British journal of anaesthesia. 2013 Jun 1;110(6):896-914.
8. Bahammam AS, Singh T, Esquinas AM. Mechanical Ventilation in the Critically Ill Obese Patient. Respir Care. 2018; 63(2): 227-37.
9. Taradaj J. Prevention and treatment of pressure ulcers by newest recommendations from European Pressure Ulcer Advisory Panel (EPUAP): practical reference guide for GPs. Family Medicine & Primary Care Review. 2017 Jan 1;19(1):81-3.
10. Raurell-Torredà M, Romero-Collado A, Rodríguez-Palma M, Farrés-Tarafa M, Martí JD, Hurtado-Pardos B, Peñarrubia-San Florencio L, Saez-Paredes P, Esquinas AM. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. Enfermería Intensiva (English ed.). 2017 Jan 1;28(1):31-41.
11. Ahmad Z, Venus M, Kisku W, Rayatt SS. A case series of skin necrosis following use of non invasive ventilation pressure masks. International wound journal. 2013 Feb;10(1):87-90.
12. Krithikadatta J. Normal distribution. Journal of conservative dentistry: JCD. 2014 Jan;17(1):96.
13. Araújo F, Ribeiro J, Oliveira A, Pinto C, Pais-Ribeiro J, Oliveira A, et al. Validação do Índice de Barthel numa amostra de idosos não institucionalizados. Rev Port Saúde Pública. 2007;25(April 2007):59–66.
14. Reith FC, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AI. Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54,069 patients with traumatic brain injury. Injury. 2017 Sep 1;48(9):1932-43.
15. Reith FC, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AI. Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54,069 patients with traumatic brain injury. Injury. 2017 Sep 1;48(9):1932-43.
16. Kondrup J, Ramussen HH, Hamberg O, Stanga Z, Camilo M, Richardson R, et al. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.
17. Santaeugènia SJ, Mas MÀ, Tarazona-Santabalbina FJ, Alventosa AM, García M, Monterde A, Gutiérrez A, Cunill J. Does the presence of pressure ulcers entail “high risk of negative outcomes” in geriatric rehabilitation? Results from a retrospective cohort study. Nutricion hospitalaria. 2017;34(6):1305-10.
18. Barros LS, Talaia P, Drummond M, Natal-Jorge R. Facial pressure zones of an oronasal interface for noninvasive ventilation: a computer model analysis. Jornal Brasileiro de Pneumologia. 2014 Dec;40(6):652-7.
19. Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. International wound journal. 2010 Oct;7(5):358-65.
20. Barros LS, Talaia P, Drummond M, Natal-Jorge R. Facial pressure zones of an oronasal interface for noninvasive ventilation: a computer model analysis. Jornal Brasileiro de Pneumologia. 2014 Dec;40(6):652-7.
21. Santaeugènia SJ, Mas MÀ, Tarazona-Santabalbina FJ, Alventosa AM, García M, Monterde A, Gutiérrez A, Cunill J. Does the presence of pressure ulcers entail “high risk of negative outcomes” in geriatric rehabilitation? Results from a retrospective cohort study. Nutricion hospitalaria. 2017;34(6):1305-10.
22. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clinical Nutrition. 2010 Feb 1;29(1):47-53.
23. Choi J, Choi J, Kim H. Nurses’ interpretation of patient status descriptions on the Braden Scale. Clinical nursing research. 2014 Jun;23(3):336-46.
24. da Silva Martins MD, Ribas PS, Sousa JR, da Silva NA, Preto LS, Correia TI. Facial pressure ulcers in inpatients undergoing non-invasive ventilation in intermediate care units/Úlceras de pressão na face em doentes submetidos a ventilação não invasiva hospitalizados em cuidados intermédios/Úlceras por presión en la cara en pacientes sometidos a ventilación no invasiva hospitalizados en cuidados intermédios. Revista de Enfermagem Referência. 2016 Jul 1;4(10):103.
25. Choi J, Choi J, Kim H. Nurses’ interpretation of patient status descriptions on the Braden Scale. Clinical nursing research. 2014 Jun;23(3):336-46.
26. Dyer A. Ten top tips: Preventing device-related pressure ulcers. Wounds Int. 2015;6(1):9–13.
27. Ham HW, Schoonhoven LL, Schuurmans MM, Leenen LL. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department. International emergency nursing. 2017 Jan 1;30:13-9.
28. Dhandapani M, Dhandapani S, Agarwal M, Mahapatra AK. Pressure ulcer in patients with severe traumatic brain injury: significant factors and association with neurological outcome. Journal of clinical nursing. 2014 Apr;23(7-8):1114-9.
29. Schallom M, Cracchiolo L, Falker A, Foster J, Hager J, Morehouse T, Watts P, Weems L, Kollef M. Pressure ulcer incidence in patients wearing nasal-oral versus full-face noninvasive ventilation masks. American Journal of Critical Care. 2015 Jul;24(4):349-56.
30. Yamaguti WP, Moderno EV, Yamashita SY, Gomes TG, Maida AL, Kondo CS, de Salles IC, de Brito CM. Treatment-related risk factors for development of skin breakdown in subjects with acute respiratory failure undergoing noninvasive ventilation or CPAP. Respiratory care. 2014 Oct 1;59(10):1530-6.
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IssueVol 7 No 2 (2020): Spring QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v7i2.2731
Keywords
non-invasive ventilation; pressure ulcer; intermediate care facilities; critical care nursing

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How to Cite
1.
Quitério C, Cordeiro I, Pereira M. Associated factors of facial pressure ulcers in patients under non-invasive ventilation during hospital stay in an intermediate care facilities of a Portuguese hospital. NPT. 2020;7(2):97-105.