A 63-year-old female is admitted from a regional hospital to ICU for respiratory support
following an emergency laparotomy for an acute abdomen ten days previously. The findings
on examination include the following lesion as depicted in the image below:
a) What complication has developed?
b) What are the risk factors for this complication?
c) What is the management of this complication?
d) What are the major preventative strategies for this complication in Intensive Care patients?
Pressure area ulcer
Duration of surgery
Faecal incontinence and/or diarrhoea
Low albumin concentrations
Disturbed sensory perception
Moisture of the skin
Use of inotropic drugs
Too unstable to turn, or other reason for decreased mobility,
High APACHE II score. Waterlow’s score, Braden’s score or other valid scores
Remove all pressure from area
Appropriate wound management
Plastic surgical review
Wound nurse team.
Bowel management system.
Maintaining clean and dry skin
Visualise skin integrity twice a day
Regular pressure relief and pressure relief mattresses
Yep, that's a pressure area.
This question is essentially a repat of Question 29.2 from the first paper of 2009, Question 7 from the first paper of 2007 and Question 2d from the first paper of 2003.
Modifiable risk factors
Non-modifiable risk factors and comorbidities
Associated disease states:
Keller, Paul B., et al. "Pressure ulcers in intensive care patients: a review of risks and prevention." Intensive care medicine 28.10 (2002): 1379-1388.
Cullum, N., et al. "Beds, mattresses and cushions for pressure sore prevention and treatment." The Cochrane Library (2000).
REULER, JAMES B., and THOMAS G. COONEY. "The pressure sore: pathophysiology and principles of management." Annals of Internal Medicine94.5 (1981): 661-666.
Health Quality Ontario. "Pressure Ulcer Prevention: An Evidence-Based Analysis." Ontario health technology assessment series 9.2 (2009): 1.
Stratton, Rebecca J., et al. "Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis." Ageing research reviews 4.3 (2005): 422-450.
Henzel, M. Kristi, et al. "Pressure ulcer management and research priorities for patients with spinal cord injury: consensus opinion from SCI QUERI Expert Panel on Pressure Ulcer Research Implementation." J Rehabil Res Dev 48.3 (2011): xi-xxxii.
Theaker, C., et al. "Risk factors for pressure sores in the critically ill."Anaesthesia 55.3 (2000): 221-224
Krupp, Anna E., and Jill Monfre. "Pressure Ulcers in the ICU Patient: an Update on Prevention and Treatment." Current infectious disease reports 17.3 (2015): 1-6.
Coyer, Fiona, et al. "Reducing Pressure Injuries in Critically Ill Patients by Using a Patient Skin Integrity Care Bundle (Inspire)." American Journal of Critical Care 24.3 (2015): 199-209.