Gerokomos (Sep 2007)
Monitorización de úlceras por presión en una Unidad de cuidados intensivos Monitorization of pressure ulcers in a critical care Unit
Abstract
Introducción: Las úlceras por presión (UPP) son un indicador de mala calidad asistencial. Los pacientes ingresados en Unidades de cuidados intensivos presentan gran número de factores de riesgo de padecer UPP, siendo de las Unidades con mayores índices de incidencia. Objetivos: Determinar la prevalencia de UPP y el paciente tipo que desarrolla UPP. Material y métodos: Estudio prospectivo de prevalencia. Variables dependientes: nº de UPP (nº de UPP excluyendo las iatrogénicas); nº de UPPY (nº de UPP iatrogénicas) y nº de UPPT (nº de UPP + nº de UPPY). Variables independientes: sexo, edad, diagnóstico, riesgo Nova 4, estadios, índice de severidad, localizaciones, fechas de registro de las UPP, medidas preventivas. Análisis: Paquete estadístico G-Stat 2.0. Descriptivo: media y desviación estándar; frecuencias relativas y absolutas. Inferencial: T-Student, ANOVA, modelo de regresión lineal. Significación estadística de pIntroduction: Pressure ulcers (PU) are an indicator of poor assistance quality. Patients in units of intensive care present a considerable number of risk factors of suffering UPP, in fact, these units are among with a higher of incidence of PUs. Objectives: To determine the prevalence of PUs and the type of patient who develops PUs. Material and methods: Prospective study of prevalence. Dependent variables: no. of PUs (no. of PUs, excluding iatrogenic ones); no. of IPUs (no. of iatrogenic PU) and no. of TPUs (no. of PUs + no. of IPUs). Independent variables: sex, age, diagnostic, risk Nova 4, stadiums, Index of severity, localizations, dates of registration of the UPP, preventive measures. Analysis: statistical package G-Stat 2.0.Descriptive:mean and standard desviation; relative and absolute frequencies. Inferential: T-Student, ANOVA, linear regression model. Statistical significance: p< 0,05; IC 95%. Results: PUs prevalenc: 12,7%; IPUs prevalence: 6,8%. 142 PUs registered, 45 of them of iatrogenic origin. More frequent localizations: sacrum and heels and nose, lips, ears for the iatrogenic ones. Causal factors of IPU: 49% were caused by endotraqueal tube and fixation system; 42% by nasogastric tube. The highest number of lesions was registered in surgical patients. Average patient: male, 63 years old, surgical diagnosis, high risk of suffering PU. A statistically significant association could only be established between the no. of PUs and the use of special surfaces for the handling of the pressure (S.D.: -0,553; 95% CI: -1,089, -0,017), p= 0, 04. Discussion: An important factor in the appearance of the PUs appears to be iatrogenic causes. To classify patients according to their risk of suffering PUs, it is critical to carry out a continuous assessment. The use of special surfaces for the handling of the pressure has a positive influence in the mean number of PUs patients present.
