Factors Predicting the Interface Pressure Related to Pressure Injury in Intensive Care Unit Patients

Ji Seon Shine; Soo Jin Kim; Ji Hyun Lee; Mi Yu

doi:10.4040/jkan.2017.47.6.794

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Shine, Kim, Lee, and Yu: Factors Predicting the Interface Pressure Related to Pressure Injury in Intensive Care Unit Patients

Original Article

J Korean Acad Nurs 2017;47(6):794-805.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.6.794

Factors Predicting the Interface Pressure Related to Pressure Injury in Intensive Care Unit Patients

Ji Seon Shine¹, Soo Jin Kim², Ji Hyun Lee³, Mi Yu^4,

¹Surgical Intensive Care Unit, Gyeongsang National University Hospital, Jinju

²Adequate Medical Support Department, Gyeongsang National University Hospital, Jinju

³Surgical Outpatient Team, Gyeongsang National University Hospital, Jinju

⁴College of Nursing · Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Address reprint requests to : Yu, Mi College of Nursing · Institute of Health Sciences, Gyeongsang National University, 816-15 Jinju-dearo, Jinju 52727, Korea Tel: +82-55-772-8229 Fax: +82-55-772-8222 E-mail: yumi825@gnu.ac.kr

Received 31 May 2017 Revised 22 November 2017 Accepted 22 November 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

Interface pressure is a factor that contributes to the occurrence of pressure injuries. This study aimed to investigate interface pressure at common sites of pressure injury (occipital, gluteal and peritrochanteric areas), to explore the relationships among risk factors, skin condition and interface pressure, and to identify risk factors influencing interface pressure.

Methods

A total of 100 patients admitted to the intensive care unit were enrolled at a tertiary teaching hospital in Korea. Interface pressure was recorded by a scanning aid device (PalmQ). Patient data regarding age, pulmonary disease, Braden Scale score, body mass index, serum albumin, hemoglobin, mean blood pressure, body temperature, and oxygen saturation were included as risk factors. Data collected from July to September 2016 were analyzed using binary logistic regression.

Results

The mean interface pressure of the occipital, gluteal, and right and left peritrochanteric areas were 37.96 (±14.90), 41.15 (±16.04), 53.44 (±24.67), and 54.33 (±22.80) mmHg, respectively. Predictive factors for pressure injuries in the occipital area were age ≥70 years (OR 3.45, 95% confidence interval [CI]: 1.19~9.98), serum albumin deficit (OR 2.88, 95% CI: 1.00~8.26) and body temperature ≥36.5^oC (OR 3.12, 95% CI: 1.17~8.17); age ≥70 years (OR 2.81, 95% CI: 1.10~7.15) in the right peritrochanteric area; and body temperature ≥36.5^oC (OR 2.86, 95% CI: 1.17~6.98) in the left peritrochanteric area.

Conclusion

Our findings suggest that old age, hypoalbuminemia, and high body temperature may be contributory factors to increasing interface pressure; therefore, careful assessment and nursing care of these patients are needed to prevent pressure injury. Further studies are needed to establish cutoff values of interface pressure for patients with pressure ulcers.

Keywords: Intensive care units, Pressure ulcer, Risk factors

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Table 1.

General Characteristics and Pressure Injury Risk Factors (N=100)

Variables	Categories		n	%	Mean±SD (range)
Gender	Male		64	64.0
	Female		36	36.0
Age (yr)	<60		36	36.0	64.97±15.91 (22~93)
	60~69		21	21.0
	≥70		43	43.0
Pulmonary disease	No		88	88.0
	Yes		12	12.0
Braden scale score	Normal (≥18)		0	00.0	11.83±1.99 (9~16)
	Low/Midium risk (10~17)		89	89.0
	High risk (≤9)		11	11.0
Body mass index (kg/m²)	≤18.4		11	11.0	22.53±3.11 (16.6~30.9)
	18.5~25.4		71	71.0
	≥25.5		18	18.0
Edema index	Normal (≤0.40)		75	76.5	0.39±0.04 (0.00~0.43)
	Edema (≥0.41)		23	23.5
Serum hemoglobin (g/dL)	≥12.0		39	39.0	11.62±1.90 (7.0~16.8)
	<12.0		61	61.0
Serum albumin (g/dL)	Normal (≥2.8)		70	70.0	3.23±0.71 (1.8~4.9)
	Deficit (<2.8)		30	30.0
Supine Mean blood pressure (mmHg)	Hypotension (<65)		13	13.0	78.41±12.60 (53~108)
	Normal (65~79)		44	44.0
	Hypertension (≥80)		43	43.0
Body temperature (°C)	<36.5		62	62.0	36.39±0.47 (35.2~38.2)
	≥36.5		38	38.0
SpO₂ (%)	<90		6	6.0	98.82±1.84 (90~100)
	≥90		94	94.0
Rt lateral Mean blood pressure (mmHg)	Hypotension (<65)		11	11.0	80.67±14.36 (59~133)
	Normal (65~79)		43	43.0
	Hypertension (≥80)		46	46.0
Body temperature (°C)	<36.5		60	60.0	36.41±0.39 (35.6~37.9)
	≥36.5		40	40.0
SpO₂ (%)	<90		2	2.0	99.00±1.43 (91~100)
	≥90		98	98.0
Lt lateral Mean blood pressure (mmHg)	Hypotension (<65)		6	6.0	79.49±11.66 (52~1113)
	Normal (65~79)		46	46.0
	Hypertension (≥80)		48	48.0
Body temperature (°C)	<36.5		51	51.0	36.56±0.45 (35.8~38.1)
	≥36.5		49	49.0
SpO₂ (%)	<90		6	6.0	98.62±1.90 (90~100)
	≥90		94	94.0
Skin condition	Supine position: No		72	72.0
	Occipital/gluteal region Redness		15	15.0
	PI stage 1		8	8.0
	PI stage 2		0	0.0
	PI stage 3		0	0.0
	PI stage 4		1	1.0
	Deep tissue injury		4	4.0
	No Lateral position:		97	97.0
	Peritrochanteric region	Yes (redness)	3	3.0
Interface pressure (mmHg)	Supine- occipital	＜32	42	42.0	37.96±14.90 (14.3~84.5)
		≥32	58	58.0
	Supine- gluteal	＜32	26	26.0	41.15±16.04 (11.7~92.4)
		≥32	74	74.0
	Rt lateral-peritrochanteric	＜45	45	45.0	53.44±24.67 (19.3~163.5)
		≥45	55	55.0
	Lt lateral-peritrochanteric	＜45	42	42.0	54.33±22.80 (18.4~153.4)
		≥45	58	58.0

PI=Pressure injury; SpO =Saturated oxygen in arterial blood; Rt=Right; Lt=Left.

Table 2.

Interface Pressure Differences by General Characteristics and Pressure Injury Risk Factor (N=100)

Variables	Categories	Supine position-occipital region				Supine position-gluteal region				Rt lateral position-peritrochanteric region				Lt peritron position-peritrochanteric region
		Mean (mmHg)	SD	F/t	p	Mean (mmHg)	SD	F/t	p	Mean (mmHg)	SD	F/t	p	Mean (mmHg)	SD	F/t	p
Gender	Male	37.05	14.86	−0.81	.418	42.23	17.07	0.90	.370	56.22	25.64	1.51	.135	56.71	22.47	1.40	.166
	Female	39.58	15.06			39.22	14.07			48.51	22.34			50.11	23.10
Age (yr)*	<60^a	32.40	10.51	4.86	.010	41.16	16.96	0.43	.650	46.12	20.61	2.70	.073	48.99	19.53	1.579	.211
	60~69^b	38.20	15.16		c>a	38.45	12.84			55.33	23.17			56.61	27.83
	≥70^c	42.50	16.57			42.45	16.83			58.65	27.38			57.69	22.37
Pulmonary	No	37.25	14.03	−1.29	.201	39.94	14.85	−2.06	.042	50.21	19.71	−2.22	.047	52.23	21.71	−2.56	.012
disease	Yes	43.13	20.21			49.97	21.80			77.16	41.34			69.73	25.66
Braden scale	e ≥10	36.98	13.71	−1.34	.209	41.13	15.60	−0.02	.984	51.20	23.38	−2.66	.009	52.42	21.43	−2.44	.016
score	≤9	45.90	21.64			41.24	20.18			71.58	28.43			69.78	28.48
Body mass	≤18.4	44.76	19.47	2.01	.140	45.99	22.68	0.43	.651	60.84	41.98	0.68	.511	59.81	27.58	0.26	.775
index	18.5~25.4	35.96	13.17			40.84	15.78			52.09	21.61			54.31	19.92
(kg/m²)	≥25.5	41.06	17.88			40.41	14.85			56.79	25.49			53.56	30.02
Edema index	x Normal	36.92	14.97	−1.10	.272	40.21	16.66	−1.22	.227	53.98	25.28	0.28	.777	54.75	24.00	0.15	.882
	(≤0.40)
	Edema	40.87	15.17			44.88	14.20			52.30	23.43			53.93	19.61
	(≥0.41)
Serum he-	≥12.0	39.65	14.33	0.91	.368	42.26	15.36	0.55	.581	54.38	30.11	0.30	.763	54.34	24.80	0.00	.998
moglobin	<12	36.88	15.28			40.43	16.55			52.84	20.72			54.33	21.64
(g/dL)
Serum	Normal	35.86	13.67	−2.19	.031	40.57	16.28	−0.54	.588	52.11	22.47	−0.83	.411	53.91	23.97	−0.28	.780
albumin	(≥2.8)
(g/dL)	Deficit (<2.8)	42.85	16.68			42.48	15.67			56.56	29.36			55.31	20.17
Mean BP*	Hypotension	42.99	18.88	2.31	.104	49.29	19.03	1.98	.144	78.08	29.71	7.20	.001	65.75	27.15	1.89	.156
(mmHg)	(<65)^a
	Normal	39.85	15.01			40.23	14.87			48.54	17.33		a>b,c	50.10	18.98
	(65~79)^b
	Hypertension	34.50	12.93			39.63	15.91			52.14	26.26			56.95	25.11
	(≥80)^c
Body tempe-	− <36.5	36.32	15.40	−1.41	.162	39.42	15.26	−1.38	.170	52.82	24.17	−0.31	.757	49.72	21.55	−2.10	.038
rature (°C)	≥36.5	40.63	13.84			43.97	17.07			54.39	25.70			59.13	23.29
SpO₂ (%)	<90	45.70	19.35	1.32	.191	44.98	24.28	0.60	.548	66.55	0.92	0.76	.451	70.72	21.75	1.84	.069
	≥90	37.47	14.57			40.90	15.53			53.18	24.85			53.29	22.58
Skin	Skin problem^†	38.28	16.60	0.29	.772	43.47	14.76	0.92	.361	78.10	43.30	1.78	.079	−	−
condition^†	No problem	37.34	13.77			40.17	16.63			52.68	23.86			54.33	22.80

*Scheffe test.

^†No patient with skin problem on Lt lateral position-peritrochanteric region.

Rt=Right; Lt=Left.

Table 3.

Interface Pressure Predictors on Occipital and Gluteal Regions in the Supine Position

Variables	Categories	Supine position-occipital region pressure							Supine position-gluteal region pressure
		b	SE	Wald	p	OR	95% CI		b	SE	Wald	p	OR	95% CI
							lower	upper						lower	upper
Age (yr)	60~69	0.22	0.60	0.14	.713	1.25	0.39	4.01	−0.12	0.67	0.03	.862	0.89	0.24	3.31
	≥70	1.24	0.54	5.21	.022	3.45	1.19	9.98	−0.31	0.56	0.32	.573	0.73	0.25	2.17
PD	Yes	−0.50	0.78	0.40	.526	0.61	0.13	2.81	0.41	0.90	0.21	.648	1.51	0.26	8.73
BSS	High risk (≤9)	−0.02	0.73	0.00	.983	0.98	0.23	4.14	−	−	−	−	−	−	−
Alb	Deficit (<2.8)	1.06	0.54	3.85	.049	2.88	1.00	8.26	0.56	0.58	0.94	.334	1.74	0.57	5.39
mBP	65~79	−0.36	0.77	0.22	.639	0.70	0.15	3.15	−1.01	0.87	1.34	.248	0.36	0.07	2.02
	≥80	−0.57	0.75	0.58	.445	0.56	0.13	2.46	−0.77	0.87	0.79	.376	0.46	0.09	2.53
BT (°C)	≥36.5	1.14	0.50	5.21	.022	3.12	1.17	8.27	1.06	0.56	3.55	.060	2.90	0.96	8.75
(constant)	−0.46	0.78	0.35	.552	0.63			1.46	0.89	2.66	.103	4.29
Model fitness		-2LL (log likelihood)=118.86 (c²=17.20, df=8, p=.028), Hosmer-Lemeshow (c²=11.22, p=.190), Accuracy of classification: 65.0%							-2LL=1108.03 (c²=6.58, df=7, p=.474), Hosmer-Leme-show (c²=2.82, p=.901), Accuracy of classification: 74.0%

Reference: Age<60; PD=No; BSS≥10; Alb=Normal (≥2.8); mBP<65; BT<36.5.

Alb=Serum albumin; BSS=Braden scale score; BT=body temperature; mBP=Mean blood pressure; PD=Pulmonary disease.

Table 4.

Interface Pressure Predictors on Peritrochanteric Region in the Lateral Position

Variables	Categories	Rt lateral position-Peritrochanteric region pressure							Lt lateral position-Peritrochanteric region pressure
							95% CI							95% CI
		b	SE	Wald	p	OR	Lower	Upper	b	SE	Wald	p	OR	Lower	Upper
Age (yr)	60~69	0.43	0.56	0.59	.443	1.54	0.51	4.62	−	−	−	−	−	−	−
	≥70	1.03	0.48	4.69	.030	2.81	1.10	7.15	−	−	−	−	−	−	−
PD	Yes	−	−	−	−	−	−	−	1.32	0.83	2.53	.111	3.73	0.74	18.86
BSS	High risk	1.38	0.82	2.80	.095	3.97	0.79	19.93	0.98	0.76	1.68	.195	2.67	0.61	11.78
	(≤9)
mBP	65~79	−	−	−	−	−	−	−	−1.40	1.17	1.42	.234	0.25	0.03	2.47
	≥80	−	−	−	−	−	−	−	−1.34	1.18	1.28	.257	0.26	0.03	2.65
BT (°C)	≥36.5	−	−	−	−	−	−	−	1.05	0.46	5.32	.021	2.86	1.17	6.98
(constant)		−0.45	0.35	1.66	.197	0.64			0.90	1.15	0.61	.436	2.45
Model fitness		-2LL=128.83 (c² =8.80, df=3, p=.032), Hosmer-Lemeshow (c²=0.27, p=.874), Accuracy of classification: 61.0%							-2LL=123.46 (c² =12.60, df=5, p=.027), Hosmer-Lemeshow c²=2.69, p=.747), Accuracy of classification: 67.0%

Reference: Age<60; PD=No; BSS≥10; Alb=Normal (≥2.8); mBP<65; BT<36.5.

PD=pulmonary disease; BSS=Braden scale score; mBP=mean blood pressure; BT=Body temperature; SE=standard error; OR=odds ratio; CI=confidence interval.

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