Pressure injury risk factors in critical care patients: a descriptive analysis

Background: Critically ill patients require complex care in a technologically sophisticated environment and as such are exposed to a plethora of pressure injury (PI) risk factors. Despite the application of evidence-based prevention strategies, PIs do occur and unavoidable PIs can result.  

Study Objectives: 1) to describe the risk factors associated with PI development in a sample of medical-surgical ICU (MSICU) patients and 2) to determine if these risk factors were congruent with the work of the National Pressure Ulcer Advisory Panel on unavoidable PIs.

Methods: A retrospective, descriptive design was used to describe the PI risk factors present in a sample of 57 MSICU patients who acquired a PI during their ICU admission.  Variables under investigation: demographics; severity of illness/mortality variables; comorbidities; nutritional factors; vasopressor agents; measures of hemodynamic instability; severe anemia; immobility; shock state; mechanical ventilation; head of bed(HOB) elevation; sedation or neuromuscular blocking agents; operative procedure/hours.

Results: The most frequently identified risk factors were immobility (n=57; 100%), septic shock (n=31; 54%), vasopressor use (n=37; 65%), HOB elevation > 30⁰(n=53; 93%), sedation (n=50; 87.7%), and mechanical ventilation > 72 hours (n=46; 81%). The most common PI location/stage were the sacrum (56%; n=32), and deep tissue PI (68%; n=39). Mean number of days to PI development was 7.5 (SD 7.2).

Conclusions: Results of this descriptive study were congruent with the literature surrounding the clinical situations that predispose patients to unavoidable PIs. While the implementation of PI prevention strategies is tantamount to reducing PI rates, recognition that in certain populations, such as the critically ill, exposure to certain risk factors may potentially escalate risk and go beyond the scope of prevention. Recognition of these risk factors is significant in our journey to differentiate PIs that result from prevention failure from those that may be unavoidable and as such prevention immune.