Purpose: The purpose of this study was to identify systemic blood flow and oxygenation risk factors for pressure ulcer development in critically ill patients. Conceptual Framework: The Braden Scale is based on strong epidemiologic evidence associating deficits in mobility, activity, sensory perception, moisture, nutrition, and friction & shear with pressure ulcer development. Evidence associating deficits in systemic blood flow and oxygenation to pressure ulcers is inconsistent. Subjects: Thirty-five subjects were selected who were admitted to a critical care unit between October 1, 2000 and September 24, 2003; had a flow-directed pulmonary artery (PA) catheter; and were pressure ulcer-free on admission. Method: This historic cohort study is based on review of existing medical records. Serial data were collected one day prior to PA catheter insertion, on the day of insertion and for three days following insertion. Results: Six of thirty-five subjects developed pressure ulcers for a 17% incidence rate in this select group. Mean age was 63.29 (+ 10.65) years with no significant differences between groups. Thirty-four subjects were male. Although mean Braden scores were lower in those developing pressures ulcers, differences were not significant. Pressure ulcer positive subjects had significantly higher APACHE II chronic health points (F=91.43, p=.000), and smoking pack-year histories (F=-2.92, p=.007). On the day of catheter insertion, those with pressure ulcers had significantly lower systolic blood pressure (F=2.70, p=.011), diastolic blood pressure (F=2.08, p=.045) and mean arterial pressure (F=2.43, p=.021). No significant differences were found for lowest cardiac index, highest pulmonary artery wedge pressure, highest systemic vascular resistance or any of the parameters of arterial or mixed venous blood gas analysis. Conclusions: Those developing pressure ulcers demonstrated significantly lower systolic, diastolic, and mean arterial pressures on the day of PA catheter placement and nonsignificant trends of higher oxygen needs over the course of the study.
This work was supported by a Veterans Affairs postdoctoral fellowship.
Session #1192 - Acute Care
The 29th Annual MNRS Research Conference (April 1-4, 2005)