Patients in the intensive care unit (ICU) often have serious health problems called pressure sores, which make their conditions worse and increase their risk of death or severe illness. Pressure on the skin, soft tissue, muscle, and bone for a long time, usually over bony prominences, causes these wounds. ICU patients are especially at risk because they can’t move and have poor blood flow because they are critically sick. The number of reported pressure ulcers in the ICU varies greatly, from 3.3% to 39.3%. Pressure sores can cause dangerous diseases, longer stays in the hospital, slower recovery, and higher costs for care. So, preventative steps are essential for this group of patients more likely to get sick.
A critical part of a complete plan to avoid pressure ulcers in the ICU is mattresses that are made to relieve and redistribute pressure. This literature review aims to look at the available data on how well pressure-relieving mattress systems work compared to regular beds in lowering the number of pressure sores in adult ICU patients (Chan et al., 2020). Does using a pressure-relieving mattress instead of a traditional mattress lead to a lower rate of pressure sores over time in adult ICU patients aged 18 and up? This is the specific PICO clinical question. Adults in the intensive care unit (ICU) are the group; a pressure-relieving mattress is the remedy, and a standard mattress is the comparison. The result is the number of pressure ulcers that happen over time. These study results can help guide practices based on facts to help keep skin healthy in the ICU.
Chan et al. (2020) – Code Blue During the COVID-19 Pandemic
Findings: This publication examined the obstacles surrounding cardiac arrest resuscitation events within intensive care units throughout the COVID-19 health crisis. Pressure ulcers were not addressed. Implications: Despite not providing applicable evidence on pressure sores, this paper illustrates the mounted intricacy of critical care during a widespread outbreak. This stresses the importance of preventive techniques.
During the COVID-19 outbreak, Chan et al. (2020) looked at the unique problems that Code Blue events caused. Even though the study wasn’t directly about pressure ulcers, it shows how much more difficult it is to provide care in the ICU during a public health emergency. ICU resources and staff were put under a lot of stress because it was hard to get entire Code Blue teams to get personal protective equipment (PPE), there were risks of aerosolization and surface contamination, and there was a need to decontaminate. This shows how important it is to take precautions to keep other problems from happening in people who are very sick. Even though the study wasn’t specifically about pressure sores, it shows how important the ICU setting has become and what that means for protected care.
Griffiths et al. (2019) – Guidelines on the Management of Acute Respiratory Distress Syndrome
Findings: The authors developed best practice recommendations for treating acute respiratory distress syndrome. The prevention or treatment of pressure ulcers was not explored. Implications: Though properly managing acute respiratory distress syndrome is imperative in the ICU, the research does not detail pressure injuries. Further studies on their interrelation are warranted.
In the same way, Griffiths et al. (2019) suggested the best ways to treat acute respiratory distress syndrome (ARDS) without actually looking into pressure sores. Because ARDS causes severe hypoxemia, anesthetics and paralytics may be needed, which makes the patient even less mobile and vulnerable. The standards recommend lung-protective breathing techniques, lying on your back, muscle-blocking drugs, and managing fluids. These are all important for respiration but could hurt the skin’s structure and blood flow. The paper has a significant effect on the outlook for ARDS, and the complicated, invasive respirator and drug treatments probably raise the risk of pressure ulcers. The study stresses the importance of balancing actions that save lives and those that keep other problems from happening.
Mueller et al. (2019) – Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference
Findings: This consensus concentrated on patient blood management tactics. Pressure ulcer occurrence was not evaluated. Implications: Despite offering valuable blood regulation guidance, the work does not provide pressure ulcer avoidance insights.
Mueller et al. (2019) are experts in controlling blood in patients and have devised suggestions for preventing anemia and reducing blood loss. The paper affects skin health, even though it doesn’t discuss pressure sores. Anemia can harm tissue aeration, and blood loss can hurt circulation. On the other hand, blood transplants have risks, such as too much fluid being given. Because these things can lead to pressure ulcers, controlling anemia and blood loss is essential in preventing them. The guidelines don’t talk about pressure sores directly. Still, they stress how important it is to improve breathing and circulation in critically sick people to keep them from getting problems like skin breakdown.
Tibi et al. (2021) – STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management
Findings: This updated clinical recommendations on patient blood optimization but did not examine pressure ulcer rates. Implications: Though integral for ICU blood regulation, the paper needs to focus on this literature review’s primary emphasis on pressure ulcers.
Tibi et al. (2021), who updated evidence-based instructions on controlling a patient’s blood, found the same. Taking care of anemia and saving blood may improve the oxygen supply to muscles, which may indirectly help the skin stay alive. But the focus is still only on managing blood, not side effects like the number of pressure ulcers. Still, when looking at all the parts of seriously ill patients’ care, it seems likely that implementing the suggested blood improvements would have a good effect on their skin health. More study is needed to link with presdirectly sure sores directly, but the suggestions support attempts to avoid them by improving blood flow.
Weiss et al. (2020) Surviving Sepsis Campaign International Guidelines for Managing Septic Shock and Sepsis-Associated Organ Dysfunction in Children.
Findings: This guideline outlined pediatric septic shock treatment without directly analyzing pressure ulcers. Implications: It contributes to better pediatric sepsis outcomes yet does not offer pressure ulcer deterrence insights for adult populations. Finally, Weiss et al. (2020) focus on treating septic shock in children and come up with treatment standards that are very different from those used for adults in the intensive care unit and pressure sores. Some suggested medicines are antimicrobials, vasoactive drugs, and additional treatments like diet and blood sugar management. While the study significantly affects how sepsis is treated in children, the community, treatments, and result measures are very different from how pressure sores are prevented in adults. So, more research would have to be done before any conclusions from the study could be applied to skin safety in adult ICU patients. Still, if we think about integrating patient care, stopping sepsis as a cause of organ failure could help blood flow and lower the risk of pressure ulcers, even though there isn’t much data directly on this link.
None of these five studies prove that their treatments led to better results for people with pressure ulcers. However, several have reasonable theoretical links that should be explored further. All of these things show how hard and complicated it is to help people who are very sick, which makes other problems like skin breakdown more likely. More studies that measure how different ICU treatments and their bodily effects affect the development of pressure ulcers would greatly assist efforts to stop them in places where people are receiving intensive, life-sustaining care.
The studies we looked at add to what we know about other areas of clinical practice, but they also show that we need to learn more about how to use pressure-relieving beds to help prevent pressure sores in adult ICU patients. None of the pieces directly look into how the type of mattress affects the development of pressure sores or try to figure out how these skin-protecting gadgets affect skin breakdown in people in the ICU. The fact that there isn’t any study on this specific group of patients, remedy, comparison, or result is a significant problem that needs to be fixed. To build a body of data for this clinical problem, we need more randomized controlled studies in the adult ICU that compare pressure-relieving beds to regular mattresses.
To make things move forward, wound care experts and ICU providers need to be made more aware of this study gap to encourage more research. Researchers should look for grant money to help pay for the first test studies to inform us how beds affect the number of pressure ulcers in intensive care units. If the results show pressure-relieving devices work, they should be tested in more extensive, controlled studies. This would make it easier to do meta-analyses that can be used to guide systematic reviews. Once there is enough proof that using pressure-relieving beds lowers the risk of pressure ulcers, new evidence-based standards, and procedures can make it official that high-risk patients in the ICU should use them.
To sum up, the study has big holes examining how pressure-relieving beds can help keep adult ICU patients from getting pressure ulcers. Due to the lack of proof, it is hard to come to any valid conclusions or suggestions about applying them best. The power of the evidence can grow by focusing more research on this group of patients and comparing different mattress systems. With enough well-designed studies, it might be possible to lower the number of pressure ulcers in the ICU by using easy-to-adopt solutions like pressure-relieving beds. More study is still needed to progress in this area of medicine.
References
Chan, P. S., Berg, R. A., & Nadkarni, V. M. (2020). Code Blue During the COVID-19 Pandemic. Circulation: Cardiovascular Quality and Outcomes, 13(5). https://doi.org/10.1161/circoutcomes.120.006779
Griffiths, M. J. D., McAuley, D. F., Perkins, G. D., Barrett, N., Blackwood, B., Boyle, A., Chee, N., Connolly, B., Dark, P., Finney, S., Salam, A., Silversides, J., Tarmey, N., Wise, M. P., & Baudouin, S. V. (2019). Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respiratory Research, 6(1), e000420. https://doi.org/10.1136/bmjresp-2019-000420
Mueller, M. M., Remoortel, H. V., Meybohm, P., Aranko, K., Aubron, C., Burger, R., Carson, J. L., Cichutek, K., Buck, E. D., Devine, D., Fergusson, D., Folléa, G., French, C., Frey, K. P., Gammon, R., Levy, J. H., Murphy, M. F., Ozier, Y., Pavenski, K., & So-Osman, C. (2019). Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA, 321(10), 983–997. https://doi.org/10.1001/jama.2019.0554
Tibi, P., McClure, R. S., Huang, J., Baker, R. A., Fitzgerald, D., Mazer, C. D., Stone, M., Chu, D., Stammers, A. H., Dickinson, T., Shore-Lesserson, L., Ferraris, V., Firestone, S., Kissoon, K., & Moffatt-Bruce, S. (2021). STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. The Annals of Thoracic Surgery, 112(3), 981–1004. https://doi.org/10.1016/j.athoracsur.2021.03.033
Weiss, S. L., Peters, M. J., Alhazzani, W., Agus, M. S. D., Flori, H. R., Inwald, D. P., Nadel, S., Schlapbach, L. J., Tasker, R. C., Argent, A. C., Brierley, J., Carcillo, J., Carrol, E. D., Carroll, C. L., Cheifetz, I. M., Choong, K., Cies, J. J., Cruz, A. T., De Luca, D., & Deep, A. (2020). Executive Summary: Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21(2), 186–195. https://doi.org/10.1097/PCC.0000000000002197
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