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PubMed2001

Factors influencing the development of decubitus ulcers in critically ill surgical patients.

INTRODUCTION: Decubitus ulcers confer significant morbidity to critically ill patients. We sought to determine which patient factors contributed to the formation of decubitus ulcers in our critically ill patients, and hypothesized that these ulcers occurred most often in elderly patients with lengths of stay >7 days and high severity of illness. METHODS: This study was conducted prospectively in two phases. Phase I provided an initial analysis of patients who developed decubitus ulcers in the surgical intensive care unit (ICU) of New York Weill Cornell Center from January 1, 1993, to June 1, 1997. In phase II of the study, a comparison study was made for patients with ICU length of stay (ULOS) >7 days admitted to the same ICU from January 1, 1998, to August 31, 1998. Age, APACHE III score, systemic inflammatory response syndrome (SIRS score), multiple organ dysfunction syndrome (MODS) score, admission status, days without nutrition, ULOS, mortality, days to formation of decubitus ulcers, Cornell ulcer risk score, and other demographic features were recorded. Univariate and multivariate analysis of variance were performed to analyze independent risk factors for development of decubitus ulcers; p <.05. RESULTS: In phase I, 2,615 patients were admitted to surgical ICU over the study period. One hundred and one decubitus ulcers occurred (incidence 3.8%) during phase I, but the incidence of decubitus ulcers increased significantly over time to 9% (p <.01). Thirty-three decubitus ulcers occurred among the 412 patients (incidence 8.0%) during phase II. Multivariate analysis revealed that emergent admission (odds ratio [OR] 36.00, 95% confidence interval [CI] CI 0.2290-0.7694), age (OR 1.08, 95% CI 0.0026-0.0131), days in bed (OR 1.05, 95% CI -0.0013-0.0156, and days without nutrition (OR 0.51, 95% CI -0.1095--0.0334) were independent predictors of a decubitus ulcer. CONCLUSIONS: The incidence of decubitus ulcers is increasing in critically ill patients. Emergency ICU admission and ULOS >7 days in elderly patients confer significant risk for the formation of decubitus ulcers. Specific interventions targeting this high-risk population that may be instituted to decrease the incidence of decubitus ulcers include early nutrition, early mobilization, and possibly less noxious bedding surfaces.

APACHE↗
PubMed1979

[Effect of aerobic and anaerobic germs on the healing of decubitus ulcers].

Bacteriological examinations of decubitus ulcers were performed in 34 geriatric patients. A total of 179 wound swabs were analyzed for aerobic and anaerobic bacteria. The decubitus ulcers were divided into three groups according to wound healing: group A with progressive worsening, group B, stationary, and group C with healing within 10 weeks. The aerobic bacteria isolated from the three groups were significantly different (p less than 0.0001). In group A Pseudomonas aeruginosa was isolated in 88%, enterococci in 73% and Providentia in 34%, whereas in group B staphylococci were found in 69%, enterococci in 62% and E. coli in 32%. In group C staphylococci dominated with 91%, followed by enterococci (51%) and E. coli (25%). Anaerobic microorganisms were significantly (p less than 0.01) more frequent in decubitus ulcers with poor healing tendency (group A and B) than in healing ulcers (group C). These results suggest that bacterial growth on decubital ulcers significantly influences decubital ulcer healing. Furthermore, bacteriological examinations are of prognostic value and the results should be considered in treatment.

Aerobiosis↗
PubMedDate not supplied

[Incidence of decubitus ulcers in an intensive care unit].

Decubitus ulcers are an important problem which must be known by health professionals in general and by nurses in particular. Its prevention is one of the basic care in Nursing. This care becomes especially relevant in patients who are admitted into Intensive Care Units. The objectives of the study are to know the incidence rate of patients who develop decubitus ulcers during their stay in the Unit and the proposal to introduce measures aiming to decrease its incidence. In general, the study proves that 17% of patients develop decubitus ulcers during their hospitalization and that 31.8% of patients who are catalogued as risk patients develop ulcers. The preventive measures introduced are the reassessment and application of prevention and treatment of decubitus ulcers protocols, the creation of improvement groups where these problems are approached, perfecting courses about decubitus ulcers, clinical sessions where strategies are unified, graphic divulging measures (notices, etc.) and antiscaric materials such as heelers, small cushions for head support, pillows, etc.

Female↗
PubMed2005

Decubitus ulcers: a review of the literature.

Decubitus ulcers are a worldwide health care concern affecting tens of thousands of patients and costing over a billion dollars a year. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture), and internal factors (e.g. fever, malnutrition, anaemia, and endothelial dysfunction). Often, enough damage is done to create the basis for a decubitus ulcer after as little as 2 h of immobility, a situation which may be difficult to avoid if the patient must undergo prolonged surgery or remain bedridden. Damage owing to pressure may also occur hours before the patient receives medical attention, especially if the patient falls or becomes immobilized owing to a vascular event. Several classification systems for decubitus ulcers have been described, based on where injury first occurs. The histologic progression of decubitus ulcers is a dynamic process involving several stages, each having characteristic histologic features. A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates. With accurate risk assessment and preventative care, we can hope to minimize complications and mortality owing to decubitus ulcers.

Humans↗
PubMed2004

Controversies about the decubitus ulcer.

Knowledge of the decubitus ulcer has made great progress in recent decades. No longer is the diagnosis of a bedsore, as it was in the iron lung days, almost a death warrant. One cannot cause to heal a patient who is in organ failure, nor can one necessarily prevent ulcers in a new spinal cord-injured patient. Reflecting on the common cold, one realizes that prevention is limited to covering the face when sneezing, and treatment is symptomatic. There is no way of eradicating the virus of the common cold, nor is there an appropriate treatment. The decubitus ulcer should be conceived of in a similar vein, until understanding is more complete and specific treatments are available.

Aged↗
PubMed1991

[Gluteus maximus myocutaneous flap in the repair of sacral and gluteal decubitus ulcers].

16 cases of decubitus ulcers in the sacral, ischiadic and great trochanter regions were treated with rotating myocutaneous flap of the caudal portion of the gluteus maximus from 1983 to 1989. They were followed up for 3 to 68 months, with the exception of 4 patients. The results were excellent. 30 gluteus regions were studied in 15 cadavers. It was found that the caudal 3/4 of the gluteus maximus muscle was supplied by the inferior gluteal artery, and a flap measuring 12.9 x 9.7 cm could be formed therein with easy dissection. The flap tolerates pressure well. Unilateral flap is adequate to cover a decubitus ulcer within a diameter of 10cm, while bilateral flaps are necessary for a larger ulcer.

Adult↗
PubMed2006

Orthopedic management of decubitus ulcers around the proximal femur.

Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur.

Disarticulation↗
PubMed2000

[Hemodynamics of the lower extremities in patients with decubitus ulcers using the ultrasonic Doppler method].

Our clinical experience indicates that decubitus ulcers with tissue loss/necrosis extending beyond the subcutaneous fat in aged patients are liable to become refractory and that most of these patients experience a cold feeling/cyanosis in the lower extremities. In order to determine the relationship between the severity of the decubitus ulcers and the hemodynamics in the lower extremities, we conducted a blood flow test using the ultrasonic Doppler method on the lower extremities in patients. Sixty-eight inpatients (38 men, 30 women, with an average age of 80.5 +/- 7.6 years old) were selected. B-mode tomographs were obtained with an ultrasonic diagnostic apparatus. The power Doppler method was used to measure blood flow rate, vascular lumen diameter, and intravascular blood flow at the dorsalis pedis artery, posterior tibial artery, peroneal artery furcation, and femoral artery. The subjects were divided into three groups: patients without decubitus ulcers; patients with mild to moderate decubitus ulcers of IAET Classification grade I-III; and patients with severe decubitus ulcers (IAET Classification grade IV), and the measurements were compared among the groups. The results revealed a tendency for the vascular lumen to become narrowed and intravascular blood flow to be reduced at all sites as decubitus ulcers increased in severity and showed the hemodynamics in the lower extremities to be particularly poor in the severe group. We measured the hemodynamics in the lower extremity with the ultrasonic Doppler method from the viewpoint of decubitus ulcer prevention and found differences in blood flow in the lower extremities according to the severity of decubitus ulcers. A reduction in blood flow in the lower extremities is considered to indirectly indicate a susceptibility to decubitus ulcers and to serve as a sign of its exacerbation. We consequently considered the test to be useful and concluded that deterioration of hemodynamics due to the progress of arteriosclerosis is one of the causes of decubitus ulcer exacerbation.

Aged↗
PubMed2006

[Combined treatment of refractory decubitus ulcers].

OBJECTIVE: To summarize the clinical experience in the treatment of refractory decubitus ulcers. METHODS: From May 1998 to March 2005, 22 patients with decubitus ulcers (29 decubitus ulcers) were admitted, whose age was 36-92 years. The lesion size was 4 cm x 2 cm to 18 cm x 15 cm. The locations of decubitus ulcers were the sacrococcygeal region (18 cases), the tuber ischiadicus region (6 cases) and the trochanter major region (5 cases). Enteral nutrient was given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient's age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm x 4 cm-12 cm x 10 cm; 10 by fasciocutaneous flaps, 10 cm x 7 cm-20 cm x 17 cm; 9 by gluteus maximus myocutaneous flaps, 13 cm x 11 cm-17 cm x 14 cm; and 6 by long-head of biceps femoris flaps, 11 cm x 6 cm-14 cm x 7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days. RESULTS: General nutritional status was improved, hemoglobin was greater than 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a follow-up of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory. CONCLUSION: Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation.

Adult↗
PubMed1983

A randomized trial of cadexomer iodine in decubitus ulcers.

Thirty-four patients with decubitus ulcers were studied in a randomized trial to compare topical cadexomer iodine with the standard decubitus ulcer treatments used in the participating hospitals. There was a significant reduction of ulcer area with both treatments within three weeks; however, eight of 16 patients treated with cadexomer iodine had a reduction of ulcer area of more than 50 per cent, compared with one of 18 patients treated with the standard treatment (P less than 0.01). Twenty-seven patients continued the same treatment for five more weeks, during which time six in the cadexomer iodine group healed, compared with one in the standard treatment group (P less than 0.05). Cadexomer iodine was superior to the standard treatment in removing pus and debris from the ulcer surface and in reducing pain at the ulcer site. It was found to be easy both to apply and to remove from the ulcers and did not stain skin or clothing. Transient smarting during the first hour after application was reported by three patients, and one patient complained of skin irritation. The results show that cadexomer iodine applied daily has a debriding effect on decubitus ulcers and accelerates healing.

Administration, Topical↗
PubMed1983

Successful management of decubitus ulcers by the general surgeon.

Decubitus ulcers were handled by an aggressive routine of early wide excision and immediate advancement-rotation flaps of the thigh under antibiotic coverage. Of 23 patients referred for decubitus ulcers in two years, 20 were so managed, with primary healing in 15 and secondary healing in an additional four. There has been one recurrence, one operative death, and two late deaths.

Follow-Up Studies↗
PubMed1978

Sinography in management of decubitus ulcers.

Draining sinuses are considered a major complication of decubitus ulcers in spinal cord injury patients. Of 144 such patients with decubitus ulcers admitted in 1975 and 1976, 15 had draining sinuses. Twenty-one sinograms were obtained in the process of their evaluation prior to treatment. In 6 patients, sinography resulted in unexpected findings such as excessive depth of the sinus tract, abscess formation, undermining of previous graft, and extension into neighboring joints, affecting both the management of the decubitus ulcers and the surgical approach. It is concluded that sinography should become an integral part of management of decubitus ulcers with draining sinuses.

Abscess↗