Abstract
The intensive care unit-acquired weakness (ICU-AW) is an important adverse effect due to bed rest in critically ill patients. This kind of complication is a hindrance to the implementation of a fast recovery of patients. It’s mandatory for nurses to implement the ICU-AW prevention through an active collaboration in early patients’ positioning, progressive mobilization, and active collaboration during physiotherapy interventions. The only contraindications to early mobilization are hemodynamic instability, intracranial hypertension, and severe multiple bone injuries. Another major complication related to the bed rest of patients is the development of pressure ulcers (pressure injuries—PIs) in ICU. PIs’ risk assessment using the Braden scale in critical care patients is no longer recommended, since it showed a poor accuracy in predicting PIs, mainly related to the scale lack of ICU-specific risk factors such as MV, hypotension, cardiovascular instability, and ICU-LOS. Even the Cubbin-Jackson scale seems to have important limitations in ICU populations. However, the recent introduction of a new scale called COHMON (conscious level, mobility, hemodynamics, oxygenation, nutrition) index for PIs’ risk assessment seems to be promising.
References
Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care. 2009;13:216. https://doi.org/10.1186/cc7885.
Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999;354:1229–33. https://doi.org/10.1016/S0140-6736(98)10063-6.
McPeake J, Quasim T. Quality of life in intensive care survivors. Br J Nurs. 2015;24:1016. 10.12968/bjon.2015.24.20.1016.
Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev. 2014;4:Cd009958. https://doi.org/10.1002/14651858.CD009958.pub2.
Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, et al. Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med. 2003;31:1012–6. https://doi.org/10.1097/01.CCM.0000053651.38421.D9.
Asfour HI. Contributing factors for acquired muscle weakness in the intensive care unit. J Nurs Educ Pract. 2016;6:102–11. https://doi.org/10.5430/jnep.V6n8p102.
Rukstele CD, Gagnon MM. Making strides in preventing ICU-acquired weakness involving family in early progressive mobility. Crit Care Nurs Q. 2013;36:141–7. https://doi.org/10.1097/CNQ.0b013e31827539cc.
Fan E. Critical illness neuromyopathy and the role of physical therapy and rehabilitation in critically ill patients. Respir Care. 2012;57:933–44. https://doi.org/10.4187/respcare.01634.
SE H, Kannus P, Natri A, Latvala K, Järvinen MJ. Isokinetic performance of the thigh muscles after tibial plateau fractures. Int Orthop. 1997;21:323–6.
Hollander JM, Mechanick JI. Nutrition support and the chronic critical illness syndrome. Nutr Clin Pract. 2006;21:587–604. https://doi.org/10.1177/0115426506021006587.
Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev. 2014;30:CD006832. https://doi.org/10.1002/14651858.CD006832.pub3.
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238–43. https://doi.org/10.1097/CCM.0b013e318180b90e.
Foster J. Complications of sedation in critical illness: an update. Crit Care Nurs Clin North Am. 2016;28:227–39. https://doi.org/10.1016/j.cnc.2016.02.003.
Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive Care Med. 2008;34:1188–99. https://doi.org/10.1007/s00134-008-1026-7.
Krupp AE, Monfre J. Pressure ulcers in the ICU patient: an update on prevention and treatment. Curr Infect Dis Rep. 2015;17:468. https://doi.org/10.1007/s11908-015-0468-7.
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park; 2014.
National Pressure Ulcer Advisory Panel (NPUAP). Announcement of change in terminology from pressure ulcer to pressure injury. 2016. http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/. Accessed 7 Apr 2017.
Jugun K, Richard JC, Lipsky BA, Kressmann B, Pittet-Cuenod B, Suvà D, et al. Factors associated with treatment failure of infected pressure sores. Ann Surg. 2016;264:399–403. https://doi.org/10.1097/SLA.0000000000001497.
Rennert R, Golinko M, Yan A, Flattau A, Tomic-Canic M, Brem H. Developing and evaluating outcomes of an evidence-based protocol for the treatment of osteomyelitis in Stage IV pressure ulcers: literature and wound electronic medical record database review. Ostomy Wound Manage. 2009;55:42–53.
Brunel AS, Lamy B, Cyteval C, Perrochia H, Téot L, Masson R, et al. OSTEAR Study Group. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study. Clin Microbiol Infect. 2016;22:267.E1–8. https://doi.org/10.1016/j.cmi.2015.11.005.
Schiffman J, Golinko MS, Yan A, Flattau A, Tomic-Canic M, Brem H. Operational debridement of pressure ulcers. World J Surg. 2009;33:1396–402. https://doi.org/10.1007/s00268-009-0024-4.
Behrendt R, Ghaznavi AM, Mahan M, Craft S, Siddiqui A. Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit. Am J Crit Care. 2014;23:127–33. https://doi.org/10.4037/ajcc2014192.
Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013;22:2183–91. https://doi.org/10.1111/j.1365-2702.2012.04216.x.
Barrois B, Labalette C, Rousseau P, Corbin A, Colin D, Allaert F, et al. A national prevalence study of pressure ulcers in the French hospital inpatients. J Wound Care. 2008;17:373–6, 378–9. 10.12968/jowc.2008.17.9.30934.
Martin E. Concise medical dictionary. 9th ed. Oxford: Oxford University Press; 2015. Market House Books
National Institute for Health and Care Excellence (NICE). Pressure ulcers. https://www.nice.org.uk/guidance/qs89. Accessed 7 Apr 2017.
Bredesen IM, Bjøro K, Gunningberg L, Hofoss D. Effect of e-learning program on risk assessment and pressure ulcer classification—a randomized study. Nurse Educ Today. 2016;40:191–7. https://doi.org/10.1016/j.nedt.2016.03.008.
Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nurs Res. 1987;36:205–10.
Swafford K, Culpepper R, Dunn C. Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. Am J Crit Care. 2016;25:152–5. https://doi.org/10.4037/ajcc2016963.
Serpa LF, Santos VL, Campanili TC, Queiroz M. Predictive validity of the Braden scale for pressure ulcer risk in critical care patients. Rev Lat Am Enfermagem. 2011;19:50–7.
Cho I, Noh M. Braden Scale: evaluation of clinical usefulness in an intensive care unit. J Adv Nurs. 2010;66:293–302. https://doi.org/10.1111/j.1365-2648.2009.05153.x.
Hyun S, Vermillion B, Newton C, Fall M, Li X, Kaewprag P, et al. Predictive validity of the Braden scale for patients in intensive care units. Am J Crit Care. 2013;22:514–20. https://doi.org/10.4037/ajcc2013991.
Jackson C. The revised Jackson/Cubbin pressure area risk calculator. Intensive Crit Care Nurs. 1999;15:169–75.
Wheeler H. Positioning: one good turn after another? Nurs Crit Care. 1997;2:129–31.
Ahtiala MH, Soppi E, Kivimäki R. Critical evaluation of the Jackson/Cubbin pressure ulcer risk scale—a secondary analysis of a retrospective cohort study population of intensive care patients. Ostomy Wound Manage. 2016;62:24–33.
Cobos Vargas A, Garofano Jerez JR, Guardia Mesa MF, Carrasco Muriel C, Lopez Perez F, Gonzalez Ramırez AR, et al. Design and validation of a new rating scale (COMHON Index) to estimate the risk of pressure ulcer in patients attended in critical care units. Connect: The World of Critical Care. Nursing. 2011;8:41.
Fulbrook P, Anderson A. Pressure injury risk assessment in intensive care: comparison of inter-rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales. J Adv Nurs. 2016;72:680–92. https://doi.org/10.1111/jan.12825.
Cox J, Roche S. Vasopressors and development of pressure ulcers in adult critical care patients. Am J Crit Care. 2015;24:501–10. https://doi.org/10.4037/ajcc2015123.
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Giusti, G.D., Peghetti, A., Comisso, I., Bambi, S. (2018). Early Mobility, Skin, and Pressure Ulcer Risk Assessment. In: Nursing in Critical Care Setting. Springer, Cham. https://doi.org/10.1007/978-3-319-50559-6_5
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