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OBJECTIVE: To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD: An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS: A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION: There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.

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Lesão por pressão relacionada a dispositivos médicos é uma complicação bastante comum e geralmente oriunda da fixação do dispositivo utilizado na intubação endotraqueal para ventilação mecânica. Desta forma, o presente estudo reportou o caso de um paciente do sexo masculino, 65 anos, leucoderma, internado em uma unidade de terapia intensiva, e que desenvolveu lesão ulcerada na região de fixação do dispositivo utilizado para intubação orotraqueal. Após alívio da pressão local exercida, terapia de fotobiomodulação foi proposta como única estratégia para cicatrização da lesão e diminuição do edema. Após 3 sessões diárias foi possível observar excelente curso de reparação tecidual e remissão dos sinais flogísticos. De acordo com o presente caso, a terapia de fotobiomodulação parece ser bastante eficiente para o tratamento de lesões por pressão relacionada a dispositivos médicos(AU)

Medical device-related pressure injuries are very common complications and usually arise from the fixation of the device used in endotracheal intubation for mechanical ventilation. Thus, the present study reports a case of a Caucasian male patient, 65 years old, who was admitted to an intensive care unit and developed later an ulcerated lesion on the region of fixation of the device used for orotracheal intubation. After relieving the local pressure exerted, photobiomodulation therapy was proposed as the only strategy for wound healing and edema reduction. After 3 daily sessions, it was possible to note an excellent tissue repair course and remission of phlogistic signs. According to the present case, photobiomodulation therapy appears to be a quite efficient treatment strategy for medical device-related pressure injuries(AU)

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Introducción: Se suele aplicar en pacientes con SARS-CoV-2 el decúbito prono (DP) prolongadamente, pues ha demostrado beneficios para solventar la falta de equipos de ventilación mecánica; sin embargo, también tiende a producir lesiones por presión (LPP) en regiones anatómicas no experimentadas en otras prácticas. Objetivo: Calcular la incidencia de LPP en el paciente crítico de COVID-19 en DP, describir características de los pacientes y las lesiones. Metodología: Estudio observacional, descriptivo, de carácter transversal con enfoque retrospectivo. La recolección de datos se realizó en un hospital de tercer nivel de la Ciudad de México, incluyó 230 pacientes que desarrollaron LPP posterior a su ingreso. Se analizó el expediente electrónico y los registros de la clínica de heridas, la recolección de datos se generó en Excel y el análisis estadístico en el programa SPSS. Resultados: La incidencia fue de 18.05%, las LPP con esfacelo corresponden al 33.9% y las de necrosis al 40%. La localización anatómica en pabellón auricular, pómulos y tórax fue de 36.1% y 46.5% fueron lesiones de categoría III con afectación de las estructuras musculares. La correlación con el IMC demostró que pacientes con sobrepeso presentaron mayor incidencia de LPP con fibrina y esfacelo en un 60.3%. Limitación del estudio: No se consideraron variables como la carga de trabajo de enfermería. Originalidad: Esta investigación no ha sido postulada previamente en ningún órgano editorial. Conclusiones: La incidencia coincide con estudios en otros países, por lo que es necesario estandarizar las acciones para la prevención de LPP y reducir su incidencia.

Introduction: Prolonged prone decubitus (PD) is usually applied in patients with SARS­CoV­2, as it has shown benefits to solve the lack of mechanical ventilation equipment; however, it also tends to produce pressure injuries (PI) in anatomical regions not experienced in other practices. Objective: To calculate the incidence of PI in the critical patient of COVID-19 in PD, describe patient characteristics and injuries. Methodology: Observational, descriptive, cross-sectional study with retrospective approach. Data collection was performed in a tertiary level hospital in Mexico City, including 230 patients who developed PI after admission. The electronic file and wound clinic records were analyzed, data collection was generated in Excel and statistical analysis in the SPSSs program. Results: The incidence was 18.05%, PI with slough corresponded to 33.9% and those with necrosis to 40%. The anatomical location in the pinna, cheekbones and thorax was 36.1% and 46.5% were category III lesions with involvement of muscular structures. Correlation with BMI showed that overweight patients had a higher incidence of PI with fibrin and sphacel in 60.3%. Limitation of the study: variables such as nursing workload were not considered. Originality: This research has not been previously postulated in any editorial body. Conclusions: The incidence coincides with studies in other countries, so it is necessary to standardize actions for the prevention of PI and reduce its incidence.

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Introdução:Em dezembro de 2019 na China, o SARS-CoV-2 foi identificado e declaradocomopandemiapelaOrganização Mundial da Saúde.Suatransmissibilidade entrehumanos e evoluçãocomestabilidade clínicaehemodinâmica, aumentam o risco dodesenvolvimento delesões por pressãonos pacientes mais críticos.Objetivo:Identificar os principais cuidados hospitalares para manter a integridade da pele nos pacientes com COVID-19propensos a lesão por pressão. Metodologia:Estudo descritivo do tipo revisão integrativa realizado nas bases: Literatura Latino-Americana de Ciências da Saúde, Base de Dados de Enfermagem,Scientific Eletronic Library OnlineeBiblioteca Nacional de Medicina dos Estados Unidoscom osdescritores COVID-19, Lesão por pressão, Assistência ao pacienteePadrões de referência. Os critérios de inclusãoforamtextos completosdisponíveis gratuitamente, publicados entre 2019 e2021, que compartilhassem da temáticaem adultos e/ou idosos.Foramexcluídos artigos incompletos,plataformas pagas, cartae notas editor, reflexões e os artigos duplicados foram contabilizados uma vez, o idioma de origem não foi fator excludente.Resultados:Foram identificados 398 artigos potencialmente relevantes e 7 foram selecionados. As principais práticas relacionadas a prevenção de lesões por pressão em pacientes com COVID-19 apontamintervenções como o uso de checklist, avaliação periódica da pele,definiçãodo risco de desenvolvimento de lesão por pressão, mudança de decúbito conforme tolerância do paciente, uso de superfície para redistribuição de peso, cobertura profilática multicamadase controle da umidade da pele. Conclusões:As principais práticasparaevitar aslesões por pressãonos pacientes com COVID-19 no ambiente hospitalarestãoassociadas como cuidado direto ou indiretamente ligados a pele,adoção de medidas preventivas e sistemáticas dentro da realidade clínica e hemodinâmica dos pacientes (AU).

Introduction:In December 2019, in China, SARS-CoV-2 virus was identified and a pandemic was declared by the World Health Organization. Its transmissibility among humans and evolution with clinical and hemodynamic stability increases the risk of developingpressure injuries in the most critical patients.Objective:To identify the main hospital care to maintain skin integrity in COVID-19patients prone to pressure injuries.Methodology:A descriptive study of integrative review carried out in the following bases: Latin-American Health Sciences Literature, Nursing Database, Scientific Electronic Library Online and the National Library of Medicine of the United States, with the descriptors COVID-19, Pressure Injuries, Patient Care and Benchmarks. Inclusion criteria were full texts available for free, published between 2019 and 2021, which shared the subject matter in adults and/or elderly people. Incomplete articles, paid platforms, editor'sletter and notes, and reflections were excluded; duplicate articles were counted once. The source language was not an excluding factor.Results:398 potentially relevant articles were identified, 7 were selected. The main practices related to the prevention of pressure injuries in patients with COVID-19 point to interventions such as the use of checklists, periodic skin assessment, definition of the risk of developing pressure injuries, change of decubitus according to the patient's tolerance, use of surface for weight redistribution, multi-layer prophylactic coverage and skin moisture management.Conclusions:The main practices to avoid pressure injuries in patients with COVID-19in the hospital environment are associated with care directly or indirectly linked to the skin, adoption of preventive and systematic measures within the clinical and hemodynamic reality of patients (AU).

Introducción: Endiciembre de 2019, en China, el SARS-CoV-2 fue identificado y declarado pandemia por laOrganización Mundial de la Salud. Su transmisibilidad entre humanos y la evolución conestabilidad clínica yhemodinámica aumentan el riesgo de desarrollar lesiones por presión en lospacientes más críticos. Objetivo:Identificar los principales cuidados hospitalarios para mantener la integridad de la piel en pacientes con COVID-19propensos a lesiones por presión. Metodología:Estudio descriptivo del tipo "revisiónintegradora" realizado em las bases de datos: Literatura Latinoamericana de Ciencias de la Salud, Base de Datos de Enfermería, ScientificEletronic Library Online (Biblioteca Electrónica Científica en Línea) y Biblioteca Nacional de Medicina de los EstadosUnidos con los identificadores COVID-19, Lesión por Presión, Atención al Paciente y Estándares de Referencia. Loscriterios de inclusión fueron textos completos disponiblesde forma gratuita, publicados entre el 2019 y 2021, quecompartieron el tema en adultos y/o ancianos.Se excluyeronlos artículos incompletos, las plataformas pagadas,las cartas y las notas del editor y las reflexiones. Los artículos duplicados se contaron una vez. El idioma de origenno fue un factor de exclusión. Resultados:Se identificaron un total de 398 artículos potencialmente relevantes, 7fueron seleccionados. Las principales prácticasrelacionadas con la prevención de lesiones por presión em pacientes con COVID-19 apuntan a intervenciones como el uso de checklist, evaluación periódica de la piel,riesgo de lesión por presión, cambio de decúbito según tolerancia del paciente, uso desuperficie para redistribución de peso, cobertura profiláctica multicapa y control de la humedad de la piel.Conclusiones:Lasprincipales prácticas para evitar lesiones por presión en pacientes con COVID-19 en el ámbitohospitalario se asocian con cuidados directa o indirectamente vinculados a la piel, adopción de medidaspreventivas y sistemáticas dentro de la realidad clínica y hemodinámica de los pacientes (AU).

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SUMMARY OBJECTIVE: The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS: This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS: For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS: Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.

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The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79-9.5) cm2 for group I, 0.54 (0.47-1.16) cm2 for group II and 26.76 (17.25-41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.

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As instituições de saúde têm recebido clientes mais exigentes quanto à qualidade dos serviços prestados. Nessas instituições, a governança corporativa ganhou espaço e credibilidade ao alinhar a gestão do negócio com a da assistência à saúde, garantindo a ambos melhores resultados. Enquanto desdobramento, a governança clínica é uma ferramenta sistematizada em pilares de ações, aplicável a diferentes contextos e práticas de saúde, proporcionando melhorias na qualidade clínica do cuidado, por meio de políticas e diretrizes responsáveis por manter e monitorar padrões de boas práticas e de resultados. As lesões por pressão, por serem consideradas fatores que influenciam negativamente na avaliação dos indicadores da qualidade assistencial e impactam nos custos assistenciais, tornam-se cenário adequado para a aplicação da governança clínica para sua gestão assistencial. Conceitualmente, a lesão por pressão é um dano localizado na pele e ou tecidos moles subjacentes, geralmente, sobre uma proeminência óssea ou relacionada ao uso de dispositivo médico ou a outro artefato, resultante de pressão intensa e ou prolongada em combinação com outros fatores de risco. Assim, reconhece-se a necessidade de uma gestão mais eficaz desse problema de saúde para sua prevenção e tratamento. Diante do exposto, o objetivo deste estudo foi elaborar um instrumento de gestão das lesões por pressão nos pacientes em internação hospitalar, por meio da aplicação da ferramenta da governança clínica. Trata-se de uma Pesquisa Convergente Assistencial, que se caracteriza pela realização de melhoramentos na prática assistencial de saúde e enfermagem, por meio da introdução de inovações. Os dados foram resultantes de uma revisão sistemática de escopo da literatura científica nas bases de dados: Literatura Latino-americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, e Web of Science. A amostra de 63 artigos analisada foi do período de 1999 a 2019, em português, espanhol e inglês As principais estratégias identificadas foram relacionadas à equipamentos e materiais para prevenção, boas práticas de cuidado, educação e treinamento, avaliação de risco, envolvimento multiprofissional, participação das gerências no processo, auditoria, mudança de comportamento e de cultura, suporte administrativo, nutrição, implantação de programa para incontinentes, seleção de equipe com interesse na área, comunicação, compromisso, controle mensal dos indicadores e a sua divulgação, registros, comissão de feridas, profissional especializado, levantamento de equipamentos presentes na instituição e levantamento de custos. Diante desses resultados, criou-se um instrumento de gestão das lesões por pressão baseado em estratégias para sua prevenção direcionada para a equipe interdisciplinar e para a mensuração da eficácia no processo. Considerou-se que a gestão das lesões por pressão deve ter como propósito gerenciar os processos de prevenção e de tratamento, proporcionando um cuidado adequado para cada tipo de cliente, de acordo com seu risco de desenvolver este tipo de lesão. Os dados mostraram que a redução da incidência das lesões por pressão nos hospitais deve-se a associação de uma assistência de enfermagem de qualidade com um processo de gestão estratégica das lesões por pressão. Destaca-se que esse processo deve contar com envolvimento de gestores e de uma equipe interdisciplinar, uso de tecnologias inovadoras e suporte contínuo de um enfermeiro estomaterapeuta, para mensurar a eficácia do processo e capacitar a equipe assistencial.

Health institutions have been receiving demanding clients concerned about the quality of care provided. In these institutions, corporate governance makes headway and earns credibility. It is due to the alignment of the management of the business and the management of the health care assistance keeping better results for both sides. As a part of this governance, clinical governance is a tool systematized into pillars of action, applicable to different contexts and health practices. This governance has been providing improvements in the quality of clinical care. It happens due to their policies and guidelines for maintaining and monitoring standards of good practices and results. In this way, as pressure injuries considered a negative factor influencing the assessment of indicator of the quality of care, and also have an impact on care costs, they become a suitable scenario to the application of the clinical governance for their care management. Conceptually, pressure injury is local damage to the underlying skin and / or soft tissues, usually on a bony prominence or related to the use of a medical device or other artifacts resulting from intense and / or prolonged pressure combined with other factors of risk. Based on the aforementioned, it is necessary more effectiveness in the management of this health problem in prevention and treatment moments. This study aimed to develop a pressure injury management tool of inpatients using the clinical governance tool. It is a Convergent Care Research characterized by improvements in healthcare and nursing practice through the introduction of innovations in this context. The data gathered in a systematic scoping literature review of the Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, e Web of Science databases. The sample of 63 articles analyzed was from 1999 to 2019 in Portuguese, Spanish and English. The main strategies identified were equipment and materials for prevention, good practices care, education and training, risk assessment, multi-professional involvement, related to the participation of managers in the process, audit, change in behavior and culture, administrative support, nutrition, implementation of a program for incontinent, selection of a team with an interest in the area, monthly control of indicators and dissemination of them, communication, commitment, records, wound commission, specialized professional, survey of equipment present at the institution and cost analysis. An instrument for the management of pressure injuries was created based on these results. The instrument has strategies of prevention directed at the interdisciplinary team and of measurements of the process effectiveness. It concluded that the management of pressure injuries must have the purpose of managing the prevention and treatment processes, providing adequate care for each type of client according to their risk of developing the injury. The literature review demonstrated that an incidence reduction of pressure injury in hospitals is needed, but to do that depends on the quality of nursing care associated with a whole process of strategic management of injuries. It is noteworthy that this process must have the involvement of managers, an interdisciplinary team and the use of innovative technologies, in addition to the continuous support of a stomatherapist nurse. The stomatherapist nurse can measure the effectiveness of the entire process and educate the entire care team about the issue.

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Purpose: Pressure injuries are a complication due to spinal cord injury. The objective of the study is to compare the pressure distribution in the wheelchair seat of subjects with spinal cord injury using 3 pads (Roho®, Varilite® and Jay®). Methods: Pressure analysis was performed on 10 participants in two situations: (a) the participant sitting in static posture and (b) with the wheelchair being used for locomotion. Results: In the static position: Jay® showed the best rates for average pressure and also the contact area, the Roho® had the lowest average for the peak pressure. During the wheelchair moving, Jay® showed the best average pressure, Roho® had a lower average for peak pressure and Varilite® provided a highest means for the contact area of the buttocks and thighs. Conclusions: The use of appropriate cushion is an effective measure in people with spinal cord injury. Implications for Rehabilitation Pressure injuries are a complication due to spinal cord injury. Study to compare the pressure distribution in the wheelchair seat of subjects with spinal cord injury is important to minimize the injuries resulting from pressure injuries. The comfort resulting from the use of the cushion suited to the demands of the subjects with spinal cord injury is fundamental for the process of rehabilitation and social participation of the people affected. Understanding and minimizing pressure points can contribute to the appropriate rehabilitation process.

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BACKGROUND: Pressure injuries are an important health care issue. This problem is even more evident with patients with neurological conditions. OBJECTIVE: This study aims to develop an analytical tool to predict the magnitude of the maximum stresses developed at the wheelchair cushion-patient contact area. METHOD: Newton's polynomial interpolation method was applied in order to obtain correlations between the maximum stress developed and the weight of the patient and the maximum pressure and body mass index (BMI) of the participants. For this study it was recruited five able-bodies and nine patients with spinal cord injury. RESULTS: The agreement between the computed stress values and those measured with the able-bodied group is excellent, but in the patients within the spinal cord injury group, the concordance is poor. The correlations were applied in data from Crawford's study, and predictions of pressures show lack of agreement. CONCLUSIONS: Correlation between the weight of a person and the maximum stress developed by him or her while sitting for extended periods of time has been demonstrated. The lack of agreement between estimated and measured values in spinal cord injuries and Crawford's data can be mainly attributed to some sort of neurological status.

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