Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients.
OBJECTIVE
To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations.


METHODS
Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24hours of intubation.


METHODS
Tissue interface pressure was measured continuously using the XSENSOR pressure mapping system (XSENSOR Technology Corporation, Calgary, Canada). Skin integrity was observed at all sites, twice daily, using the National Pressure Ulcer Advisory Panel staging system, for the first seven ICU days and at day 10 and 14.


RESULTS
Of the 132 subjects, 90.9% had no observed changes in skin integrity. Maximum interface pressure was above 32mmHg virtually 100% of the time for the sacrum, left and right trochanter. At the 45mmHg level, the left and right trochanter had the greatest amount of time above this level (greater than 95% of the time), followed by the sacrum, left and right scapula, and the left and right heels. Similarly, at levels above 60mmHg, the same site order applied. For those six subjects with sacral skin integrity changes, maximum pressures were greater than 32mmHg 100% of the time. Four of the six sacral changes were associated with greater amounts of time above both 45mmHg and 60mmHg than the entire sample.


CONCLUSIONS
Maximum tissue interface pressure was above critical levels for the majority of the documented periods, especially in the sacrum, although few changes in skin integrity were documented. Time spent above critical levels for mean pressures were considerably less compared to maximum pressures. Maximum pressures may have reflected pressure spikes, but the large amount of time above the critical pressure levels remains substantial.
Adult Health and Nursing Systems Department of the School of Nursing, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: mjgrap@vcu.edu.
Mary Jo
MJ
Grap
College of Nursing, University of South Florida, Tampa, FL, United States.
Cindy L
CL
Munro
Biomedical Engineering Department, School of Engineering, Virginia Commonwealth University, Richmond, VA, United States.
Paul A
PA
Wetzel
Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, OH, United States.
Christine M
CM
Schubert
Biomedical Engineering Department, School of Engineering, Virginia Commonwealth University, Richmond, VA, United States.
Anathea
A
Pepperl
Adult Health and Nursing Systems Department of the School of Nursing, Virginia Commonwealth University, Richmond, VA, United States.
Ruth S
RS
Burk
Department of Surgery, Virginia Commonwealth University Heath System, Richmond, VA, United States.
Valentina
V
Lucas
D000328:Adult; D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods; D002170:Canada; D016638:Critical Illness / Q000534:rehabilitation*; D005260:Female; D005269:Femur / Q000098:blood supply / Q000293:injuries; D006365:Heel / Q000098:blood supply / Q000293:injuries; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011312:Pressure / Q000009:adverse effects*; D003668:Pressure Ulcer / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012447:Sacrum / Q000098:blood supply / Q000293:injuries
Critical care; Mechanical ventilation; Pressure ulcers; Tissue interface pressure