title: Risk factors for pressure ulcer development in Intensive Care Units: A systematic review.
abstract: BACKGROUND
  Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients.
  
  
  METHODS
  The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered.
  
  
  RESULTS
  From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning.
  
  
  CONCLUSIONS
  There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development.
authors: Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España.
authors: M
authors: M
authors: Lima Serrano
authors: Unidad de Gestión Clínica (UGC) de Cuidados Intensivos, Hospital Virgen del Rocío, Sevilla, España. Electronic address: mariai.gonzalez.sspa@hotmail.com.
authors: M I
authors: MI
authors: González Méndez
authors: Unidad de Cuidados Intensivos, Hospital San Juan de Dios, Bormujos, Sevilla, España.
authors: F M
authors: FM
authors: Carrasco Cebollero
authors: Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España.
authors: J S
authors: JS
authors: Lima Rodríguez
mesh_terms: D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
keywords: Factores de riesgo; Intensive care units; Pressure ulcers; Risk factors; Unidades de cuidados intensivos; Úlceras por presión