Incidência e fatores de risco de lesão por pressão e outras lesões cutâneas de pacientes de terapia intensiva coronariana

Abstract

Pressure injury prevention is considered a patient safety goal and the responsibility of the professional team at all levels of health care. The study aimed to estimate the incidence of pressure injuries and confounding injuries in patients admitted to a coronary intensive care unit of a university hospital. Epidemiological and observational study. The intensive care unit, the study setting, is part of a large university hospital in Southeast Brazil. The sample consisted of 223 patients hospitalized from April 2018 to April 2019. Data collection took place from July 2019 to September 2020. A database review was carried out from November 2022 to January 2023. by pressure (incontinence-associated dermatitis, friction injury, medical adhesive-related injury) on admission. Those patients who did not record data in their medical records regarding three or more variables were excluded from the study. The data for completing the collection form were extracted from the patient's medical record. The main outcome was pressure injury and the secondary outcome was confounding injury. It was found that 150 (67.3%) patients were at risk for pressure injuries, using the Braden Scale, at the time of admission, with a risk reduction after 72 hours and at discharge from the unit. The overall incidence was 16.6%, considering 19 patients with pressure ulcers and other injuries. The incidence of pressure injuries was 9.0%, with 12 patients with injuries to bony prominences and seven with injuries related to medical devices, an incidence of 6.7% for medical adhesive injuries, 5.4% for incontinence-associated dermatitis, and 4% for friction injuries. The frequency of pressure injuries ranged from one to three in the same patient, totaling 23 (30.3%) occurrences, 15 (65.2%) in a region of bony prominence and eight (34.8%) by medical device. The total number of medical adhesive injuries was 19 (25.0%). Friction injuries occurred in nine patients, totaling 17 injuries (22.4%), with a frequency of one (6/66.7%), three (2/22.2%), or five (1/11.1%) injuries per patient. The risk factors for the development of lesions were enteral nutrition, mechanical ventilation, fecal incontinence and use of a diaper with an indwelling urinary catheter. This study was able to estimate the incidence of pressure injuries in patients admitted to a specialized ICU at a university hospital, in order to contribute to nursing care, with emphasis on improving practice and recording by the nursing team.