Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients.
Mary Jo Grap, Cindy L Munro, Paul A Wetzel and 4 others
PMID 27836262WHAT IT FOUND
Among 132 ventilated ICU patients, peak pressures over the sacrum and trochanter often exceeded 32 mmHg, yet only 7 developed new skin changes.
Nurses should still monitor these sites and redistribute pressure.
Key findings
01Only 7 of 132 analysed patients developed skin integrity changes during observation.
02Maximum tissue interface pressure was above 32 mmHg for 99.9% of sacrum and trochanter observations, and above 60 mmHg for 74% to 79% of trochanter observations.
03Patients who developed skin changes had trends toward more time above critical pressures than the whole sample, but this was not statistically tested because only seven had changes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was descriptive, not a test of a treatment, so it cannot show that any intervention prevented or caused skin changes. Only 132 patients were analysed and only seven developed changes during observation, which is too few to test the pressure-skin relationship. Not every patient had complete pressure data or twice-daily skin observations, so some exposure and skin changes may have been missed. The sample mixed medical, surgical and neuroscience ICU patients with different illness severity, body mass index and pressure ulcer risk, so the pressure pattern may not apply to every ventilated patient. Most patients had a sacral skin barrier and a specialised support surface, which may have changed the number of skin lesions seen.
The easy way to misread this
Do not read the low number of new skin changes as proof that high interface pressures are safe. The study did not test an intervention, and only seven patients developed changes, so it cannot show whether pressure exposure caused skin injury or whether prevention stopped it.