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ISSN 1561-2961 (Print)

2014, Number 2

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Rev Cuba Enf 2014; 30 (2)

Relationship between Apache II and the development of pressure ulcers in critical trauma patients

Burbano LMC, Chinchilla J, García J, Serrano D

Language: Spanish
References: 18
Page:
PDF size: 206.49 Kb.


ABSTRACT

Objective: to establish the cause and effect relation of the variables considered in APACHE II and skincare, as risk factors for the development of pressure ulcers in patients critical due to trauma.
Method: a cohort study based on the review of medical records of critical trauma patients admitted to two Intensive Care Units in Cali during 2011-2012. The sample was 87 medical records for exposed with an APACHE II score equal to or greater than 10, and 110 for unexposed with an APACHE II score equal to or lover than 9. Criteria inclusion: over 18 years of age, hospital stays longer than 48 hours, diagnosed with any kind of trauma requiring surgery. Exclusion: presence of pressure ulcers upon admission to the intensive care unit. The dependent variable was pressure ulcers, while the independent variables were multiple trauma; the APACHE II variables. Simple linear regression and Chi-square were used to determine the association of the independent variables with the dependent variable. The relative risk (RR) for the magnitude of these associations.
Results: the incidence of pressure ulcers was 53 %. There was significant statistical association between the development of pressure ulcers and changes in temperature (p = 0.050, RR = 1.13), respiratory rate (p=0.035, RR=1.14), hypoxemia (p=0.02. RR=1.24) and serum sodium (p=0.022, RR=1.57). 63% of the 87 patients with APACHE II equal to or greater than 10, developed pressure ulcers (p=0.017, RR=1.2).
Discussion: changes in the physiological variables of APACHE II can predict the development of pressure ulcers in critical trauma patients, making it possible to include them in the nursing scales used for prevention of pressure ulcers.


REFERENCES

  1. República de Colombia, Ministerio de la Protección Social. Prevenir úlceras por presión: Guía técnica “Buenas prácticas para la seguridad del paciente en atención de salud”. Santafé de Bogotá: Ministerio de la Protección Social; 2009.

  2. Denis A, Sam P, Mohammad S, P Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement. JCN 2008;17:646-53.

  3. Almirall D, Leiva Rus, A, Gabasa P. La escala APACHE III: un factor pronóstico en la aparición de úlceras por presión en una Unidad de Cuidados Intensivos. Enfermería Intensiva 2009;20(3):95-103.

  4. Medical Advisory Secretariat. Pressure ulcer prevention: an evidence-based analysis. Ontario Health Technology Assessment Series 2009;9(2):10-104.

  5. Yepes D, Molina F, León W, Pérez E. Incidencia y factores de riesgo en relación con las úlceras por presión en enfermos críticos. Medicina intensiva 2009;33(6):276-81.

  6. Miller PS. In economics as well as medicine prevention is better than cure. Age Ageing 2004;33(3):217-8.

  7. Anthony D, Parboteeah S, Saleh M, Papanikolaou P Norton, Waterlow and Braden scores: a review of the literature and comparison between the scores and clinical judgement. Journal of Clinical Nursing 2008;17:646-53.

  8. Defloor T, Grypdonck M. Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing 2004;48:613-21.

  9. Agency for Health Care Policyand Research. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline [Internet]. US Rockville 1992 [citado May 2013]. Disponible en:http://www.google.com.

  10. Terekeci H, Kucukardali Y, Top C, Onem Y, Celik S, Öktenli C. Risk Assessment study of the pressure ulcers in intensive care unit patients. European Journal of Internal Medicine 2009;20:394-7.

  11. Dennis R. Cómo estimar el tamaño de la muestra en investigaciones con humanos. Acta Med Colomb 1989;14(2):92-9.

  12. Ordóñez Ca, Pino LF, Tejada JW, Badiel M, Loaiza JH, Mata LV, et al. Experiencia en dos hospitales de tercer nivel de atención del suroccidente de Colombia en la aplicación del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma. Rev. Col. Bras. Cir 2012;39(4):255-62.

  13. Chang A, Peña A, Tamargo O, Jiménez R, Pardo B. Evaluación del pronóstico de mortalidad por los índices de gravedad Apache II y IV. Rev Cub Med Int Emerg 2012;12(1):2334-57.

  14. Mica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. Journal of Trauma Management & Outcomes 2013;7:6.

  15. Manzano F et al. Pressure ulcer incidence and risk factors in ventilated intensive care patients. Journal of Critical Care 2010;25:469-76.

  16. Anthony D, Rafter L, Reynolds T, Aljezawi M. An evaluation of serum albumin and the sub-scores of the Waterlow score in pressure ulcer risk assessment. Journal of tissue viability 2011;20:89-99.

  17. Pender L, Frazier S. The Relationship between dermal pressure ulcers, oxygenation and perfusion in mechanically ventilated patients. Intensive and critical care nursing 2005;21:29-38.

  18. Leijon S, Bergh I, Tersttapen K. Pressure ulcer prevalence, use of preventive measures, and mortality risk in an acute care population: a quality improvement project. J Wound Ostomy Continence Nurs 2013;40(5):469-74.




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