A Prospective, Descriptive Study of Characteristics Associated with Skin Failure in Critically Ill Adults
- 0 Comments
- 6552 reads
When the occurrence of various combinations of organ system failures was evaluated, it was found that 23 of the 29 patients (79.3%) had diagnoses that included renal and respiratory system failures, while 15 patients (52%) had diagnoses including renal and respiratory failure as well as sepsis. Of the numerous combinations of organ system failures, these were the most frequently noted combinations.
Nutritional status. Information collected on nutritional status showed that 24 patients (82.8%) experienced generalized edema and five (17.2%) were considered malnourished at the time skin failure was noted. A total of eight patients (27.6%) were receiving enteral feeding and six (20.7%) were receiving parenteral feeding at the time the skin failure was observed.
Mechanical system assistive devices. The most prevalent device used was a ventilator. The majority of patients (25, 86.2%) were on a ventilator when skin failure was observed, and 16 (55.2%) were on continuous renal replacement therapy (CRRT). Two other assistive devices found to be in use in skin failure patients were hemodialysis (n = 6, 20.7%) and a ventricular assistive device (n = 1, 3.4%).
Pressure redistribution. Several different pressure redistribution/support surfaces were in use in the facility. Most of the patients with skin failure were on a TotalCare (Hill-Rom, Batesville, IN) mattress (n = 18, 62.1%). Others were on a Sof-Care® overlay (Gaymar Industries, Orchard Park, NY) (n = 4, 13.8%), Excel Care® with air (Hill-Rom, Batesville, IN) (n = 2, 6.9%), Excel Care® with foam (n = 1), Envision® (Hill-Rom, Batesville, IN) (n = 1), and Flexicare® (Hill-Rom, Batesville, IN) (n = 1) support surface. Wrist restraints were in use on five patients (17.2%).
Vasopressive medications. Eleven patients (11, 37.9%) were being treated with more than one vasopressive agent, nine patients (31%) were not receiving any vasopressive medication, and nine were prescribed a single agent at the time that skin failure was noted. The most common vasopressive medication in use was norepinephrine (n = 17, 58.6%), followed by vasopressin (n = 9, 31.0%). Dopamine and phenylephrine each were used in five cases (17.2%). Dobutamine and epinephrine each were used in two cases (6.9%). Milrinone was in use in one patient (3.4%) (see Table 3).
Sedatives. Sedative medications also were in common use, especially fentanyl (n = 21, 72.4%). Other sedating medications used included propofol (n = 13, 44.8%), lorazepam (n = 6, 20.7%), morphine (n = 2, 6.9%), midazolam (n = 1, 3.4%), and hydromorphone (n = 1, 3.4%) (see Table 3).
Data analysis. Analysis of the continuous variables (laboratory values, highest recorded temperature, and lowest recorded mean arterial pressure) showed a significantly positive correlation between glucose level and white blood cell count (r = .373, P = .046) and between admission weight and current weight (r = .915, P = .000 (see Table 4). However, current weight information was missing for 14 patients. Significantly negative correlations were found between highest recorded temperature and hemoglobin level (r = -.390, P = .040) and highest recorded temperature and liver failure (r = -.379, P = .047), while a positive correlation was found between sepsis and renal failure (r = .435, P = .019).
No significant correlations were found among nutritional status variables. With regard to mechanical assistive devices, only one significant correlation was found between CRRT and hemodialysis (r = -.567, P = .001).