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Liu YF, Cong W, Zhou CM, Yu Y, Zhang XJ. Relationship between inflammatory factors, lactic acid levels, acute skin failure, bad mood, and sleep quality. World J Psychiatry 2025; 15:102763. [DOI: 10.5498/wjp.v15.i4.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/26/2024] [Accepted: 02/08/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND The central link between septic shock and acute skin failure (ASF) is the inflammatory response, which occurs throughout disease progression and can lead to systemic inflammatory response syndrome. Patients often experience bad moods, sleep disorders, and other health issues. Despite recognizing these factors, no studies have examined the correlation between inflammatory factors, lactic acid levels, ASF, mood disturbances, and sleep quality in critically ill patients. We hypothesize that higher levels of inflammatory factors and lactic acid are associated with more severe ASF and poorer mood and sleep quality, which may inform clinical treatment for septic shock and ASF.
AIM To explore the relationship between inflammatory factors, lactic acid levels, the severity of ASF, bad mood, and sleep quality.
METHODS The retrospective study included 150 patients with septic shock from the Second Hospital of Dalian Medical University, categorized into ASF (n = 35) or non-ASF groups (n = 115). We compared the peripheral blood inflammatory factors, including tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), lactic acid levels, skin mottling score (SMS), modified early warning score (MEWS), self-rating depression scale (SDS), self-rating anxiety scale (SAS), and Pittsburgh sleep quality index (PSQI) scores. Pearson correlation analysis assessed relationships among these variables.
RESULTS The ASF group had significantly higher levels of CRP (19.60 ± 4.10 vs 15.30 ± 2.96 mg/mL), IL-6 (298.65 ± 48.65 vs 268.66 ± 33.66 pg/L), procalcitonin, lactic acid (8.42 ± 2.32 vs 5.70 ± 1.27 mmol/L), SMS [0 (0, 1) vs 3 (2, 3)], MEWS (9.34 ± 1.92 vs 6.48 ± 1.96), SAS (61.63 ± 12.03 vs 53.71 ± 12.48), SDS (60.17 ± 12.64 vs 52.27 ± 12.64), and PSQI scores (14.23 ± 3.94 vs 8.69 ± 2.46) compared with the non-ASF group (all P < 0.001). Pearson correlation analysis revealed that IL-6, CRP, TNF-α, and lactic acid were positively correlated with SMS, MEWS, SAS, SDS, and PSQI scores (P < 0.05).
CONCLUSION Peripheral blood levels of IL-6, CRP, TNF-α, and lactic acid correlate positively with SMS, MEWS, SAS, SDS, and PSQI in critically ill patients with ASF.
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Affiliation(s)
- Yu-Fei Liu
- Department of Emergency Critical Care Medicine, The Second Hospital of Dalian Medical University, Dalian 116027, Liaoning Province, China
| | - Wen Cong
- Department of Psychiatry, Dalian Seventh People’s Hospital (Dalian Mental Health Center), Dalian 116023, Liaoning Province, China
| | - Chang-Ming Zhou
- Department of Emergency Critical Care Medicine, The Second Hospital of Dalian Medical University, Dalian 116027, Liaoning Province, China
| | - Yang Yu
- Department of Intensive Care Medicine, The Second Hospital of Dalian Medical University, Dalian 116027, Liaoning Province, China
| | - Xin-Jie Zhang
- Department of Intensive Care Medicine, The Second Hospital of Dalian Medical University, Dalian 116027, Liaoning Province, China
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Yang X, Yan F, Xie S, Shang Y, Wang M, Wen D, He H. Acute skin failure knowledge, attitudes and practices amongst intensive care unit nurses in China: A multicentre cross-sectional survey. Int Wound J 2025; 22:e70099. [PMID: 39800335 PMCID: PMC11725354 DOI: 10.1111/iwj.70099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/28/2024] [Accepted: 09/30/2024] [Indexed: 01/16/2025] Open
Abstract
PURPOSE To investigate the knowledge, attitudes and practices of intensive care unit (ICU) nurses regarding acute skin failure (ASF) and analyse the influencing factors thereof. METHODS From 22 December 2023 to 24 January 2024, a cross-sectional study was conducted amongst ICU nurses from 21 hospitals in eight provinces in China. The ASF knowledge, attitude and practice scores were determined using questionnaires, and multiple linear regression was used for further analysis. RESULTS Overall, 304 ICU nurses completed the survey. The knowledge, attitude and practice scores were 24.89 ± 10.93, 40.67 ± 5.93 and 43.47 ± 9.19, with scoring rates of 45.25%, 81.34% and 72.45%, respectively. Multiple linear regression analysis showed that being a wound ostomy specialist nurse was positively correlated with the knowledge dimension score (p < 0.05). Nurses' professional titles significantly affected attitude scores (p < 0.05); the higher the professional title, the more positive the attitude towards ASF. CONCLUSION The attitudes and practices of ICU nurses in China towards ASF were found to be positive; however, their knowledge levels need improvement. Nursing managers should conduct targeted training, especially for entry-level nurses.
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Affiliation(s)
- Xiuru Yang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Fenglin Yan
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Sha Xie
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Yinju Shang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Mei Wang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Dan Wen
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Haiyan He
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
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Zhu LH, Shen YF, Ren Q, Lin J. Construction of a Risk Prediction Model for the Occurrence of Acute Skin Failure in Critically Ill Patients: A Prospective Study. J Nurs Res 2024; 32:e338. [PMID: 39046359 DOI: 10.1097/jnr.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The risk factors for acute skin failure (ASF), a serious complication of the skin, are not fully understood. PURPOSE This study was designed to explore the risk factors for ASF in critically ill patients and construct a clinical prediction model. METHODS Intensive care unit patients were prospectively observed and assigned into two groups: with and without ASF. A logistic regression model was constructed, and its predictive power and clinical utility were evaluated. RESULTS Of the 204 eligible patients enrolled as participants, 58 (28.43%) developed ASF. Sepsis, vasoactive drugs, and age were shown to be risk factors for ASF, whereas peripheral perfusion index ratio and albumin level were shown to be protective factors. The area under the receiver operating characteristic curve was 0.83. The maximum Youden index of the model was 0.39 (specificity: 0.87, sensitivity: 0.77). The Hosmer-Lemeshow test (p = .20) and calibration curve showed good fitness and predictive utility with respect to the model. CONCLUSIONS The developed model effectively predicts ASF risk, allowing for the early identification of high-risk patients. Identifying risk factors such as sepsis, vasoactive drugs, and age and considering protective factors such as peripheral perfusion index and albumin levels may help optimize care plans. Clinical staff should pay special attention to these factors and their impact on skin health in critically ill patients.
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Affiliation(s)
- Li-Hong Zhu
- MSN, RN, Intensive Care Specialist Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan-Fei Shen
- PhD, MD, Professor, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qi Ren
- MSN, RN, Intensive Care Specialist Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Juan Lin
- MSN, RN, Head Nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
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Fu L, Chen Y, Lin L, Xu Z, Zhuang Y. Knowledge, attitude, and practice of critical care nurses and their influence on acute skin failure patients in China: A multicenter cross-sectional study. Jpn J Nurs Sci 2024; 21:e12582. [PMID: 38217104 DOI: 10.1111/jjns.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/15/2024]
Abstract
AIM Acute skin failure (ASF) can happen in critically ill patients. Therefore, adequate knowledge and skills regarding ASF are essential to manage this disorder. The aim of this work was to investigate the nurses' knowledge, attitude, and practice (KAP) regarding ASF patients and to analyze its influencing factors in the intensive care unit. METHODS A multicenter cross-sectional study was performed in 10 tertiary hospitals in March 2022. Eligible nurses received a survey with a self-designed questionnaire about their KAP regarding ASF, which included three dimensions and a maximum score of 120. A higher score corresponded to better KAP. RESULTS A total of 255 nurses participated in this study. The mean KAP score was 75.6 ± 16.9. The mean scores of the knowledge, attitude, and practice dimensions were 26.2 ± 10.6, 38.2 ± 6.1, and 11.3 ± 4.3, respectively. The dimensions were ranked according to score (from low to high) as follows: knowledge (2.6 ± 1.1), practice (2.8 ± 1.1), and attitude (3.8 ± 0.6). Multivariate linear regression analysis showed that more training sessions and an advanced professional title were associated with higher KAP scores. CONCLUSIONS The overall KAP score on ASF was low in nurses. Nurses had a positive attitude towards ASF, but their knowledge and practice required significant improvement. Those who had received more training and held a more advanced professional title exhibited higher KAP scores regarding ASF. Therefore, nurse managers should establish a relevant knowledge training system, strengthen relevant training, and improve nursing practices for ASF in order to achieve a high level of KAP in nurses who treat ASF patients.
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Affiliation(s)
- Lisang Fu
- Department of Nursing, Hospital of Putian University, Putian, China
| | - Yiyuan Chen
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Libin Lin
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Zhenmei Xu
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Yaoning Zhuang
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
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Irving SY, Berry KG, Morgan S, Seiple SM, Nagle ML, Stetzer M, Tabatabaei N, Murphy S, Srinivasan V, Mascarenhas M. Nutrition association with skin integrity and pressure injury in critically ill pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S125-S138. [PMID: 37721464 DOI: 10.1002/ncp.11063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy. METHODS We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review. RESULTS Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy. CONCLUSIONS A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.
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Affiliation(s)
- Sharon Y Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Nursing and Clinical Care Services, Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katarina G Berry
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sherry Morgan
- Holman Biotech Commons, Robert Wood Johnson Pavilion, Philadelphia, Pennsylvania, USA
| | - Stephanie M Seiple
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Monica L Nagle
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Stetzer
- Wound Ostomy and Vascular Access Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeka Tabatabaei
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara Murphy
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vijay Srinivasan
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Department of Clinical Nutrition, Division of Gastroenterology and Nutrition, Philadelphia, Pennsylvania, USA
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August D, Ullman A, Coyer F. Device related pressure injuries across the critical care lifespan. Nurs Crit Care 2023; 28:6-8. [PMID: 36715234 DOI: 10.1111/nicc.12874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Affiliation(s)
- Jeffrey M Levine
- Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is a wound consultant for the New Jewish Home in Manhattan and Advantage Surgical and Wound Care based in El Segundo, California; and Associate Clinical Professor of Geriatrics and Palliative Care, Mount Sinai Beth Israel Medical Center, New York, New York. Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care (CIAC) and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York, New York. Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, is Clinical Associate Professor, School of Nursing, Rutgers University, Newark, New Jersey, and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Submitted July 9, 2021; accepted in revised form October 8, 2021; published online ahead of print November 1, 2021
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9
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García-Fernández FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Pancorbo-Hidalgo PL. Skin injuries associated with severe life-threatening situations: A new conceptual framework. J Nurs Scholarsh 2021; 54:72-80. [PMID: 34741398 DOI: 10.1111/jnu.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.
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Mileski M, McClay R, Natividad J. Facilitating Factors in the Proper Identification of Acute Skin Failure: A Systematic Review. Crit Care Nurse 2021; 41:36-42. [PMID: 33791763 DOI: 10.4037/ccn2021145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Acute skin failure is a significant medical finding for both the critical care patient and the hospital. Proper identification is key to prevention and treatment, but diagnosis of acute skin failure in critical care patients is often missed. This diagnostic oversight may be due to a lack of knowledge about acute skin failure and its presentation. OBJECTIVE To investigate the literature for facilitating factors that would ease the identification of acute skin failure for clinicians. METHODS The research team conducted a systematic literature review via PubMed, CINAHL, and Academic Search Ultimate to collect data about acute skin failure and how it might be identified. RESULTS Ten common facilitation themes around acute skin failure and its identification were found in the literature. In total, 110 examples of facilitating factors were identified. CONCLUSIONS There is little factual information available regarding the identification of acute skin failure, and the literature is lacking in this area overall. Acute skin failure may develop in the body in a number of ways, and understanding commonalities that occur in patients who experience acute skin failure and applying that information to patients in the future may assist identification.
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Affiliation(s)
- Michael Mileski
- Michael Mileski is an associate professor and program director at School of Health Administration, Texas State University, San Marcos, Texas
| | - Rebecca McClay
- Rebecca McClay is an adjunct professor at School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, West Virginia
| | - Jessica Natividad
- Jessica Natividad is a team lead in Obstetrics and Gynecology at Midland Memorial Hospital, Midland, Texas
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Pasek TA, Kitcho S, Fox S, Aspenleiter M, Mastrangelo B, Dolinich H, Butler G, Aneja R, Rohall J. Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit. Crit Care Nurse 2021; 41:71-77. [PMID: 33560429 DOI: 10.4037/ccn2021558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Tracy Ann Pasek
- Tracy Ann Pasek is a systems analyst and clinical nurse specialist, Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra Kitcho
- Sandra Kitcho is a staff nurse, Pediatric Intensive Care, UPMC Children's Hospital of Pittsburgh, and doctor of nursing practice student, Robert Morris University, Pittsburgh
| | - Sarah Fox
- Sarah Fox is a senior wound care specialist II, Wound and Ostomy Nurse Department, UPMC Children's Hospital of Pittsburgh
| | - Marit Aspenleiter
- Marit Aspenleiter is a perfusionist, ECMO Department, UPMC Children's Hospital of Pittsburgh
| | - Beth Mastrangelo
- Beth Mastrangelo is the Quality Manager, Quality Services, UPMC Children's Hospital of Pittsburgh
| | - Heidilyn Dolinich
- Heidilyn Dolinich is Lead Informatics Nurse, Clinical Informatics, UPMC Children's Hospital of Pittsburgh
| | - Gabriella Butler
- Gabriella Butler is the Director, Division of Health Informatics, UPMC Children's Hospital of Pittsburgh
| | - Rajesh Aneja
- Rajesh Aneja is a professor, Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine
| | - Jennifer Rohall
- Jennifer Rohall is a senior wound care specialist II, Wound and Ostomy Nurse Department, UPMC Children's Hospital of Pittsburgh
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Abstract
OBJECTIVE The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population. METHODS Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model. RESULTS Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively. CONCLUSIONS The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.
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The Phenomenon of Trombley-Brennan Terminal Tissue Injury in a Neonate: A Case Study. Adv Neonatal Care 2020; 20:171-175. [PMID: 31895137 DOI: 10.1097/anc.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trombley-Brennan terminal tissue injury (TB-TTI), also known as skin failure, was first identified in 2009 among critically ill adults receiving palliative care. Identification of this skin injury can be misinterpreted as a pressure ulcer. However, this phenomenon is now accepted as an early sign of impending death among critically ill adults. CLINICAL FINDINGS This case study describes TB-TTI in a terminally ill infant in a neonatal intensive care unit evidenced by intact, 2-cm oval skin discoloration on the lateral side of both knees with rapid progression in size. PRIMARY DIAGNOSIS TB-TTI was identified on the day of death in an infant with a primary diagnosis of hypoxic-ischemic encephalopathy born at 32 weeks' gestation. INTERVENTIONS The neonatal intensive care unit (NICU) team mobilized the NICU advanced care team, institution's ethical council, and "Team Lavender" to provide infant comfort measures and emotional support to the family and care givers. OUTCOMES Infant death occurred 8 hours after TB-TTI was identified. PRACTICE RECOMMENDATIONS To our knowledge, this case study of TB-TTI in a terminally ill neonate in the NICU has not been previously described in the neonatal or pediatric population. Early recognition of the phenomenon can enable the healthcare team to provide timely emotional, spiritual, and psychosocial support to the family and allow time to "be present" with the infant at "end of life." Future work should explore additional signs of TB-TTI and the occurrence rate.
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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15
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Zhang G, Zhang Y, Li M. A Modified Ponseti Method for the Treatment of Rigid Idiopathic Congenital Clubfoot. J Foot Ankle Surg 2019; 58:1192-1196. [PMID: 31679671 DOI: 10.1053/j.jfas.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
This study reviewed the efficacy of a modified Ponseti method (MP) for treating rigid clubfeet insufficiently corrected by the classic Ponseti method. Briefly, the MP consisted of 3 procedures. First, Achilles tenotomy, abductor hallucis tenotomy, and plantar fasciotomy were conducted through 3 small incisions. Second, the talocalcaneal and talonavicular joints were manually reduced. Third, plaster immobilization was introduced to maintain the initial correction. Dimeglio scores, radiographs, and pain evaluations were used to analyze outcomes. All 38 patients with 56 clubfeet enrolled in the present study achieved initial correction after the MP, followed by a mean of 3.68 ± 0.77 (range 3 to 5) cast immobilizations, which were changed each week. The average duration of treatment was 30.63 ± 6.45 days (range 23 to 47), and 6 (10.71%) clubfeet exhibited cast-related pressure injury. After a mean follow-up period of 19.71 ± 4.83 months (range 12.47 to 31.33), no child presented foot pain, and except for 1 patient with relapse, all patients received correction, with Dimeglio scores of 0.55 ± 1.06 points (range 0 to 7). The recurrence rate was 1.79% (1 of 56) at the first year. The anteroposterior talocalcaneal angle was 34.83° ± 10.65°, and the lateral talocalcaneal angle was 31.38° ± 9.86° at the last follow-up period, and both were significantly improved compared with the corresponding preoperative angles (p < .001). The anteroposterior talus-first metatarsal angle was 12.33° ± 10.04°, and the lateral calcaneal tibial angle was 74.15° ± 14.12°, which were significantly decreased compared with the preoperative values (p < .001). In conclusion, the present short-term evaluation of this minimally invasive soft-tissue release method showed promising results for treating rigid clubfoot that was not responsive to the traditional Ponseti method.
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Affiliation(s)
- Ge Zhang
- Surgeon, Orthopedic Center of Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Zhang
- Surgeon, Orthopedic Center of Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ming Li
- Professor, Orthopedic Center of Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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