Randomized Controlled Trial
Copyright ©The Author(s) 2024.
World J Clin Cases. Jul 6, 2024; 12(19): 3873-3881
Published online Jul 6, 2024. doi: 10.12998/wjcc.v12.i19.3873
Table 1 Bundled care in the management of pressure ulcers in critically Ill adults in intensive care units
Bundled care
Contents
1. Multidisciplinary collaborationEnsure collaboration among healthcare professionals, including physicians, nurses, physical therapists, dietitians, and other specialists, to develop and execute a comprehensive care plan
Hold regular interdisciplinary meetings to share information, coordinate treatment measures, and provide a unified approach to care
Nurses conducts a thorough skin inspection during each shift and recording relevant information
2. AssessmentConduct a thorough pressure ulcer assessment, including a detailed description of the wound's depth, size, shape, edge condition, and characteristics of the wound base
Evaluate the skin surrounding the wound for signs of inflammation, redness, or swelling
3. Wound cleansingUse a gentle saline solution or specialized wound cleansing solution to clean the wound with gauze or sterile cotton balls, avoiding the introduction of new bacteria
Remove necrotic tissue, exudate, and debris to ensure a clean wound surface
4. Maintain moistureUse the dressing to maintain a moist wound environment, which accelerates healing and supports new tissue growth
Change the dressing as needed, typically when the dressing changes color from dark green to light green, indicating over 70% of the silver has been released
5. Nutritional supportDietitians closely monitor the nutritional status of patients and design high-protein dietary plans to support wound healing
Ensure the patient receives adequate protein and vitamin intake to support wound healing
Provide oral nutritional supplements or enteral nutrition support through a feeding tube, depending on the patient's oral intake capacity
6. Pain managementOffer effective pain management, including medication, to alleviate wound discomfort
Use non-pharmacological methods such as heat therapy, cold compresses, or relaxation techniques to reduce discomfort and pain
7. Prevent further deteriorationEnsure regular patient repositioning t least every 2 hours to prevent prolonged pressure on the same area
Use specialized mattresses, cushions, and care pads to reduce pressure and provide appropriate support
8. EducationProvide comprehensive education to both the patient and family members, including wound monitoring, recognizing signs of infection, and proper wound care methods
Emphasize the importance of pressure ulcer prevention, including pressure distribution and turning techniques
9. Data monitoringContinuously monitor wound progress and any changes, documenting observations
Reassess the pressure ulcer's status regularly to track healing progress
Table 2 Assigning scores to parameters in the pressure ulcer scale for healing tool
Parameter
Description
Score
Surface areaDetermined by multiplying the greatest length by the greatest width0-10
0 cm²0
< 0.3 cm²1
0.3-0.6 cm²2
0.7-1.0 cm²3
1.1-2.0 cm²4
2.1-3.0 cm²5
3.1-4.0 cm²6
4.1-8.0 cm²7
8.1-12.0 cm²8
12.1-24.0 cm²9
> 24.0 cm²10
Exudate (drainage)Assessed at dressing removal before applying a topical agent0-3
None0
Light1
Moderate2
Heavy3
Tissue type0-4
Closed/resurfacedThe wound is completely covered with epithelium/new skin0
Epithelial tissueNew pink or shiny tissue/skin growing in from the edges or as islands on the ulcer surface (for superficial ulcers)1
Granulation tissuePink or beefy red tissue with a shiny, moist, granular appearance2
SloughYellow or white tissue adhering to the ulcer bed in strings or thick clumps, or is mucinous3
Necrotic tissue/escharBlack, brown, or tan tissue adhering firmly to the wound bed or ulcer edges, may be firmer or softer than surrounding skin4
Total PUSH scoreObtained by summing the scores for the above three parameters0-17
Table 3 Baseline characteristics of control and intervention groups

Total (n = 98)
Control group (n = 49)
Intervention group (n = 49)
P value
Age (yr)54 (35.5-68.5)52 (36.5-69.5)0.881
Gender
    Male 612932
    Female3720170.677
Stage
    Stage I 382018
    Stage II392118
    Stage III1266
    Stage IV211
Unstageable7160.419
Location
Coccyx 362016
Buttocks1486
Trochanter1055
Scapila844
Malleolus844
Head532
Heel 734
Elbow10280.700
Comorbid conditions
Sepsis4524210.685
Myocardial infarction1101.000
Congestive heart failure2916130.659
Cerebral vascular disease2020.495
Chronic pulmonary disease14860.774
Diabetes with complication4221.000
Diabetes without complications209110.803
Total braden at ICU admit14 (10-20) 13 (10.5-18.5)0.565
Table 4 Comparison of pressure ulcer scale for healing score before and after intervention in two groups
Time points
Control group (n = 49)
Intervention group (n = 49)
Surface area
Exudate (drainage)
Tissue type
Total scores
Surface area
Exudate (drainage)
Tissue type
Total scores
Day 07 (4-9)1 (0-2)2 (1-2)9 (5-13)6 (3-8)1 (0-2)1 (1-2)10 (5-11.5)
Day 37 (4-8.5)a1 (0-2)1 (1-2)9 (5-12.5)a5 (3-7.5)a1 (0-1)a1 (1-2)a8 (4-10.5)a
Day 67 (4-8)a1 (0-2)a1 (1-2)9 (5-12)a,b5 (2.5-7)a,b1 (0-1)a,b1 (1-2)a8 (4-9.5)a,b
Day 97 (4-8)a1 (0-2)a1 (1-2)a9 (5-12)a,b4 (2-6)a,b,c1 (0-1)a,b1 (1-2)a6 (3-9)a,b,c
Day 127 (4-8)a1 (0-2)a1 (1-2)a9 (5-12)a,b,c4 (2-6)a,b,c,d0 (0-1)a,b,c1 (1-2)a,b,c,d6 (3-8)a,b,c,d