Cath Lab Digest

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Index: Ostomy Wound Manage. 2012;58(7):32–39.

Abstract

  Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009–2011) study was conducted among PICU patients. The two pediatric mattresses — one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg — were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need).

   Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 –17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.

Keywords: clinical study, pediatric, pressure ulcer, prevention, beds

Potential Conflicts of Interest: Mr. Torra i Bou discloses he is Clinical Manager of Smith & Nephew Spain, the distributor of Carital Systems in Spain.

Literature review

  Pressure ulcers (PUs) have always been considered an adverse event associated with adulthood and old age. However, in recent decades and closely related to the extension of the use of intensive therapeutic techniques such as extracorporeal membrane oxygenation (ECMO), high-frequency oscillatory ventilation, and noninvasive mechanical ventilation (VMNI) that limit mobility, pressure in the contact zones increases, resulting in tissue ischemia; thus, PUs in the pediatric population increasingly occur. In an observational study, Zollo et al¹ described a PU incidence related to devices and support surfaces of 26% in a population of 271 children admitted to a PICU. Neidig et al’s observational study² found a prevalence of 16.9% of occipital PUs in a population of 59 children who received cardiac surgery. A retrospective study by Schmitd et al³ of two cohorts of 32 children found a 53% prevalence of PUs in the group of children treated with high-frequency mechanical ventilation, compared to a prevalence of 12.5% in the control cohort without ventilation. In their multisite prospective cohort study involving 322 patients (ages 21 days to 8 years of age) admitted to a PICU, Curley et al⁴ found a PU incidence of 27% related to support surfaces and medical devices.

  In addition, pediatric patients with neurological or disabling illnesses (myelomeningocele, congenital myopathies, and the like) that involve long periods of immobility or forced positions, as well as patients generally cared for at home, also are at risk for PUs.⁵

  Different intensive therapies used in the PICU and the medical conditions requiring hospitalization often reduce mobility.